Everyday Health—May 29, 2013
For Pro Football Hall of Fame running back Emmitt Smith, raising awareness about the condition became a personal matter once he was diagnosed with it.
“There’s a perception that gout is an old man’s disease. But I’m 44 and a former athlete, and I have it,” said Smith.
Gout occurs when a high level of uric acid in the blood forms small, needle-like crystals in joints and surrounding tissue.
“It can be very painful — you get heat, redness and swelling, all things you can’t ignore,” said Theodore R. Fields, MD, director of the rheumatology faculty practice plan at Hospital for Special Surgery. “Untreated, a gout attack will usually last four to seven days, 10 days at the most. But it has a tendency to recur, and after a period of time the episodes become more frequent.”
For patients like Smith, it can be years before gout symptoms develop — a condition known as asymptomatic hyperuricemia. “It was about 10 years ago when my physician told me my uric acid level wasn’t quite right and to be on the lookout,” said Smith, whose first flare-up was a couple of years ago.
Sudden excruciating foot pain, especially in the large joint of the big toe, is a telltale sign of gout. It can also affect other joints, including the ankles, knees, and elbows.
There are several factors that can raise your risk for gout. Red meat, shellfish, sugary beverages, and alcohol are high in chemical compounds called purines that, when metabolized by the body, form uric acid. If you’ve been diagnosed with gout, “avoiding these foods is especially important in preventing future attacks,” said Dr. Fields. Gout has also been linked to obesity, high cholesterol, high blood pressure and diabetes.
An injury to the foot may trigger a flare-up. “There are certain things about athletes that could make them more prone to attacks,” said Dr. Fields. “One is the trauma caused by running, which impacts the big toe. Dehydration can also increase the chances of getting an attack.” But Smith doesn’t believe that his gridiron years were a factor for him. “The doctor didn’t find any correlation in terms of my gout having to do with football,” he said. “It was all predicated around uric acid levels.”
Age and gender play a role. Gout is most common in men over the age of 40. It can affect women, however, especially after menopause when reduced production of the hormone estrogen leads to increased levels of uric acid.
People with a family history of gout are at greater risk. “We often make a diagnosis based on history,” said Dr. Fields. “We can also do a blood test to see if the uric acid levels are high, but sometimes those tests can be falsely negative. The best way to make a diagnosis is to take fluid out of the inflamed joint and look at it under a microscope which allows you to see crystals.”
Once you’re diagnosed with gout, there’s no cure. But medication and lifestyle changes may keep its effects under control.
Drugs used to treat gout attacks include over-the-counter or prescription anti-inflammatory drugs and the pain reliever colchicine. “Certain types of steroids like prednisone can help as well,” according to Dr. Fields. For more frequent and severe attacks, there are drugs to block production of uric acid or help the kidneys’ ability to excrete it. As with any medication, you should discuss possible side effects or drug interactions with your doctor.
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