For Men’s Health Month, gout is an important topic for men to think about. Gout is the most common form of inflammatory arthritis, with over 8.3 million Americans suffering from gout. A number of studies have shown that the frequency of gout is increasing over the last 20 years worldwide. Men develop gout much more than women, especially at younger ages. It’s rare for gout to develop in a woman before menopause, but men in their 20’s and 30’s develop gout frequently.
It’s really important for men to understand how gout develops and how important it is to treat it effectively. Gout is generally agreed to be the most “curable” of all types of chronic arthritis. Curable is in quotes because to have gout disappear from your life, you, in the great majority of cases, need to take medication to lower your uric acid indefinitely. However, if you do take the medication, it’s almost certain that over several years, your gout will eventually disappear. Most people with gout can’t control their condition just with diet, although diet is very important.
The reason diet is often not enough to control gout is that gout is a genetic disease. Gout is due to the buildup of uric acid in the body, which then deposits in many areas, especially the joints. Diet can make the buildup of uric acid even worse, but if you have a genetic tendency to build up uric acid, you will do so even if you eat the right diet.
The right diet for gout is one in which you have as little alcohol as possible (since alcohol has an effect on the kidney that keeps uric acid from coming out in the urine). The right diet also limits red meat, shellfish, and high fructose corn syrup (as in regularly sweetened sodas). There are many other foods that can increase uric acid, but we focus on these because a large study showed that these are the foods people ate a lot of prior to their first attack of gout.
Unfortunately, even the absolutely strictest diet for gout can only bring the uric acid down about 1 point and most people with gout need more than that. Also, the diet that could drop the uric acid a full point is so strict that most people would have great trouble following it. Thus, most gout patients will need medication to lower the uric acid, such as allopurinol or febuxostat (Uloric). Good news is that these medications are extremely effective at lowering the uric acid, and well-tolerated in most people. Bad news is that many studies have shown that people who start these medications often don’t stay with them (and among medications studied, gout medications were the most likely to be given up).
Why do people often not stay with medication like allopurinol? One problem is that gout is intermittent, and in-between attacks, people can forget how painful the gout was. Another is that gout often comes along with other problems, such as hypertension, and people don’t like taking medications for lots of different ailments. Remember, gout is one of our most curable conditions if the medication is continued and are well-tolerated, so it’s an especially bad thing when gout medications are often stopped.
How can we get people to stay with their gout medication? One is education about why the treatment is so important- understanding that without treatment, the gout will just keep getting worse over the years, and can damage the joints. Another is education about how gout medication can generally be taken once a day and can usually be handled without side-effects.
Men’s Health Month is a great time for men with gout to decide that it’s time to end this problem forever. This is a realistic goal, although it can take 6-12 months of treatment, sometimes even longer, for the attacks to stop. This waiting period is well worth it, as gout can be one of our most painful conditions. The more a man knows about his gout, the more likely he is to never have to suffer from it again!
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.