Ask the Expert: Dr. Theodore Fields, Rheumatologist, Answers Your Questions About Gout

Dr. Theodore Fields, Rheumatologist

Q1: Is gout a form of arthritis? What triggers gout attacks other than red meat/alcohol/rich foods?

Gout is a form of arthritis which can be extremely painful. It’s true that alcohol and certain foods, such as shellfish and red meat, can set off gout attacks. This happens for a variety of reasons:

  • Some foods have a lot of protein which gets broken down to purines, and purines get broken down to uric acid, and uric acid crystals cause the inflammation of gout.
  • Alcohol also decreases the body’s ability to get rid of uric acid in the urine, so the level rises in the blood, which can cause a gout attack.
  • However, many attacks happen in people who have eaten nothing that is especially likely to set off gout. This is because gout is a genetic disease which leads to high uric acid levels in the body. This is why most patients with gout, especially once they are getting two or more attacks in a year, need to be treated with medication to lower the uric acid.

For the very great majority of patients with severe gout, diet control alone is not enough.

Q2: My grandmother periodically battles with bouts of gout. Is there anything she can do for the pain? Due to some other conditions, she has to be careful with pain meds.

It’s common for people with gout to have other conditions, such as hypertension, ulcer or diabetes, which make it more difficult for the doctor to pick a drug that can safely control their gout. Your grandmother should work with her doctor to find a medication that is best and safest for her. Some people have so many other medical problems that the safest thing for them when they get a gout attack is to have a local steroid injection in the joint.

Q3: What can women do to prevent gout? Are these things different for men?

The prevention issues for gout are similar for men and women. If a patient is overweight, a major weight loss can reduce the uric acid level and reduce gout risk. It is worthwhile to watch your diet, especially regarding things like red meat and shellfish, and to keep alcohol consumption down. If gout attacks continue despite these precautions, as is often the case, medications such as allopurinol are extremely successful in preventing gout attacks.

Q4; Are there certain diseases or conditions that predispose people to gout?

Yes, for example, people taking diuretics for hypertension or ankle swelling have an increase in uric acid level that could cause gout attacks. Obesity increases uric acid levels. People who develop kidney disease can have increased uric acid levels and gout attacks.

Q5: Can gout do any long term damage or have any other related side effects?

Yes, long term joint damage is common in patients with severe gout. This is an important reason that patients with recurrent gout attacks don’t just ‘tough it out,’ but instead take medication to lower the uric acid. Lowering the uric acid is extremely effective in preventing joint damage.

Q6: What age does gout usually set in? Is gout genetic?

Gout most commonly starts in men in their 40’s, but can occur in the 20’s in some, and in some doesn’t start until the 80’s and beyond. Women don’t have nearly as much gout as men until they reach the menopause. Gout is most definitely a genetic disease, and many gout patients will find that a number of their relatives share the problem.

Dr. Theodore P. Fields, Rheumatologist, specializes in the treatment of gout, rheumatoid arthritis, and osteoarthritis. Throughout his career, Dr. Fields has remained active in many professional organizations and has had his work recognized numerous times. Dr. Fields holds many professional appointments, including Director of the Rheumatology Faculty Practice Plan and Co-Chairman of the Hospital for Special Surgery Web Editorial Committee.

The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.


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  1. Hello , i have been taking Uloric for 7 months. was blood checked and uric acid level is down to 5 and family doctor very happy. Problem is i am still having attacks 7 months later almost weekly or at least every two weeks. i am aware that with the crystals dissolving attacks would come. my concern now it that they are so frequent are the new attacks just coating older disolved crystals to be restored in my tissue and then dissolving and reforming again in a perpetual cycle and not really reducing the overall amount of uric in my body.

    sorry forgot to mention that i do take 2, 0.6 colchicine tablets every nite and still get attacks on a very regular basis. i am 55 and have had gout for about 15 years. started slow and evolved to probably about 6 times a year before i started the Uloric 7 months ago. it’s just that the reading i have done has all suggested that by this stage the attacks should have become much less frequent and it is going the other way. i can handle the pain if i know there is an end in sight but i am not sure about the bio-chemistry of the dissolving process and can’t find reading on it so this is why i am concerned i am stuck in a cycle of dissolving and reforming crystals. never really getting anywhere.

    thanks again


    thanks for your help.

    1. Hi Denis — It is not rare, even after 7 months, for a small number of people to still be getting a lot of gout attacks. It’s not an issue of crystals dissolving and re-forming—the main issue is how much uric acid you had deposited in your joints to start with. Taking allopurinol, or febuxostat (Uloric(R)) will gradually remove the crystals from the joint and over time (6-12 months usually but sometimes longer) gout attacks will stop. Colchicine twice a day is good for damping down the ability of the crystals to cause attacks, and you might want to take the colchicine two different times a day rather than both together. You should discuss further with your physician the best approach to attacks (for some it is non-steroidal anti-inflammatory agents such as naproxen, for some prednisone, for some local injection of steroid – depending on other medical problems you may have). Treating the attacks immediately at their onset can help shorten the flares. There are also some people who may need their uric acid lowered below 5, and you might be one of those people. There is a light in the tunnel and over time. Keeping the uric acid at a 5 level or below leads in almost every case to an end to gout attacks, but in some people the early phase of increased attacks is longer and worse than others. Since you do respond to the Uloric, and have gotten down to 5, it is likely the right medication for you for the long run. Remember that your gout was pretty bad when you started the Uloric, at 6 attacks per year, so it’s likely your total body uric acid level in your joints is high, and as you are “mobilizing” the uric acid it is common to get more flares.

  2. Hi I am looking to start a new vitamin. I have gout and I am wondering if Orange Triad vitamin would be ok to take?

    1. Hi Jason –

      Some general principles about vitamins and supplements in people with gout:

      Probably the most common vitamin people who have gout come to my office already taking is vitamin C, either as a tablet or in the form of cherry juice.

      The studies of vitamin C in gout are interesting. One study, done in volunteers without gout, found that vitamin D 500mg daily dropped the uric acid about ½ of a point—so if the uric acid was 8 it dropped to about 7.5. Note that this is a small decrease in uric acid level- and for the great majority of gout patients not enough to get them to their goal, which is less than 6. Likely even more important is a study which looked at the same amount of vitamin C in people who actually had gout—and in that group the uric acid level didn’t change at all. It may well be that in the people who actually need their uric acid lowered, who have gout, vitamin C doesn’t work. The main point here is that we have excellent medications for gout, and if an overall dietary approach to gout doesn’t do enough it seems extremely unlikely that vitamin C will make a difference.

      Regarding diet, the most important issues for gout patients are these 4 things to consider: 1) limit red meat and organ meats, 2) limit shellfish, 3) limit all types of alcohol, especially beer and 4) limit high fructose corn syrup, especially regularly-sweetened sodas.

      The most important issue about nutritional supplements and gout patients is to be careful with high protein supplements, since proteins get broken down to purines and purines to uric acid. A sudden load of purines can set off a gout attack.

      Finally, although many vitamins and supplements are safe in gout, depending on any vitamin or supplement to get your gout under control is unlikely to work. Gout is a genetic disease which causes your body to make too much or eliminate too little uric acid, and the small effects of any supplement studied to far seem very unlikely to get the uric acid low enough. Speak to your doctor about your gout—if dietary measures are not controlling your gout you likely will need medication to control it. Fortunately, gout medications have been around for many years and are well-tolerated by the great majority of people.

      – Dr. Fields

  3. My comments are for dr Fields. I read his paper on steroidal med and side effects. Was last updated in 2009. My interest id due to many symptoms that for 6 to 8 months have me in anxiety . It seams all started with dry skin and scalp then everything became slimy from head to my feet, terrible odor and itch on scalp and body. I changed everything from shampoo, soaps laundry soaps, cream and make up. everything is an allergy. I saw my Allergist and beg him to help. ba CBC test showed nothing was wrong except cholesterol. he ordered a steroid cream called and gave me sample to put on itch on face called Clodem, I researched it and is very potent. I was concerned with other interactions (I am very careful with meds) . I put med on hold till I saew Dermatologyst. I took everything hoping to discuss what is causing the allergy but he saw me for less than three minutes, did not hear what I had to say and prescribed more cream without checking my medical history. Do steroids have an effect with past TB history?

    1. “There are multiple issues here. The first seems to be that you don’t feel you were able to communicate with your dermatologist, so it seems like a good idea to get another dermatology opinion. Second, you are correct that if you use a high-potency topical steroid for a period of time it is possible that you can get systemic steroid side effects. I’m not saying whether or not the topical steroids are right for you- that is for your allergy and dermatology consultants to help you decide. I’m saying that you are correct to be concerned. Try to prevent systemic steroid side effects if you end up using potent topical steroids for a while. Finally, a history of tuberculosis would be important if you are on steroids, and even topical steroids, if used for a long time, could be an issue. The key is whether you have fully treated tuberculosis in the past. If it has been treated, then it likely isn’t a problem. The concern is a patient with tuberculosis infection, either latent or active, which is untreated or not fully treated. If that were the case with you, you should advise your physicians.” – Dr. Theodore Fields, Rheumatologist

  4. I’m 60 years of age, been suffering from gout last three months. Swelling in joint to large toe that leads to swelling throughout foot during an attack. Indomethacin seems ineffective. Shot in joint worked well when first attack was at its peak. Since then, mild dose of oral Prednisone having diminishing effect. Started Allopurinol, but stopped after a week due to attack. Trying to get gout free to restart Allopurinol, but having difficulty. Walking, even in boot, irritates joint causing swelling. Seem to be caught in a bad cycle.

    1. Hi Joe, thank you for reaching out. Dr. Theodore Fields, Rheumatologist, says: “This is a common story for people with gout. Gout tends to get worse over time. Fortunately, taking allopurinol will gradually remove the crystals from the joint and over time (6-12 months usually) gout attacks will stop. For attacks that are hard to treat, options are injection (as you had, and might have again), higher doses of prednisone, colchicine and alternative anti-inflammatory medications in the indomethacin family. I could not advise which option is best for you since it will depend on any other medical conditions you might have. One way or another, attacks of gout can be managed, although once they are going on for a while it can be difficult. One tip—when you get back on allopurinol, if you get another flare, don’t stop the allopurinol. Getting a gout flare is very common when you first start allopurinol, since allopurinol lowers the blood uric acid and ends up pulling crystals out from the joint lining. As the crystals come out, they can set off a gout attack. If you have no medical reasons not to take colchicine, your doctor might add colchicine along with allopurinol to cut down on the increase in attacks that can happen early in treatment. You need to break the cycle, stop this gout attack, then get on allopurinol and stay on it. In the long run, the prognosis for gout, if you stay on the allopurinol, is quite excellent!” It is best to consult with your treating physician so that they can determine the best course of treatment. If you wish to receive care at HSS, please contact our Physician Referral Service at 800-796-0482 for further assistance.

  5. Hello doctor
    two months before i have joint pain and burning heat like in my legs hands and neck
    in hospital check my blood samples uric acid level is 7.6 last two moths medicine continued now in hands joins a small pain but burning like heat in hand joints knee and foot, neck and shoulders actually this is high uric acid problem or any Neurological disease. I have 30 year old. I am working in computer related profession. daily 8-10hr sitting infront of computer. Its a working related disease or high uric acid problem.
    through medicine it is curable or not.
    Sir please give me a detailed replay.

    1. Hi Syamlal, thank you for reaching out. Dr. Theodore Fields, Rheumatologist, says: “Your question is important since it gets at the point that not everyone with a high uric acid has gout. Many people have a high uric acid, but have joint pain due to a different reason. On the other hand, it’s important to know if you have gout, since gout is very effectively treated, and prevented, with medication. Shoulder pain is actually uncommon with gout, so I wouldn’t want to assume that gout is what you have. Gout often gives swollen, tender and warm joints, and if you don’t have those, it makes gout less likely. Since your pain has now spread to the shoulders, feet and knees, it sounds like it would be a good idea to get a medical re-evaluation. A rheumatologist might be a good choice, or start with your internist. A more complete exam, which will include a complete physical exam and may include x-rays and more detailed blood testing, should help to narrow down what is causing your problem.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  6. Hello doctor, I have high uric acid levels but no gout, am regular at the gym. Am planning to build muscles and want to take whey protein as supplements. Is it okay? Please advice

    1. Hi Kevin, thank you for your note. Dr. Theodore Fields, Rheumatologist, says: “In general, it’s good for people with very high uric acid to avoid especially high protein diets. It’s possible that very high protein diet can set off gout. Most likely, you will tolerate it, but as a rule we advise people with high uric acid to be moderate in alcohol, red meat, shellfish and high-fructose corn syrup (as in regularly sweetened sodas) in their diet, and to avoid very high protein diets. Again, most people with high uric acid without gout don’t get gout just from their short-term diet, but it’s good to be aware that dietary issues such as very high protein diet could set things off. Perhaps moderate supplementation is your best bet.” For more information on gout, click here:

  7. In past two years have had 6 gout attacks. Uric acid level was 9. I am a female, 70, in good shape and don’t drink. Am confused because attacks happen only when I bump one foot or other, dog steps on my foot or some seemingly related trauma occurs; and pain is localized at instep of foot. Colcrys taken and pain lessons in 4-5 days. Could it be something other than gout?

    1. Hi Kit, thank you for reaching out. Dr. Theodore Fields, Rheumatologist, says: “The story you give does sound very much like gout, but of course you should be examined by a physician to make sure nothing else is going on. With multiple attacks, a high uric acid, involvement of the foot and response to colchicine (Colcrys), everything would fit for gout. Gout can be set off by trauma, so that part of your story fits for gout also. Gout is a genetic disease, and comes out at an older age in women, and can certainly happen in people who don’t drink (or even people who don’t eat red meat or shellfish.) If you have gout and are having so many attacks, you should discuss with your doctor taking medication to lower uric acid. Once you have been on the medication for 6 months or so, gout attacks generally dramatically decrease. Often for the first 6 months of treatment to lower uric acid, your doctor may suggest taking daily colchicine to prevent gout flares. After that, you could likely stop the colchicine (Colcrys) and just continue the medicine to keep the uric acid low.” It is best that you consult with your treating physician. If you are interested in care at HSS, please call our Physician Referral Service at 877-606-1555 for further assistance.

  8. Gout can present in a number of ways, although the most usual is a recurrent attack of acute inflammatory arthritis (a red, tender, hot, swollen joint).

  9. I am 54 and was diagnosed with gout about a year ago. I am not on meds. Any info on gout treatment and especially on foods to avoid and foods that might help would be appreciated.