Your four-step plan for managing gout
“Gout is one of the most common forms of inflammatory arthritis, it’s one of the most badly managed, and it’s the only one that’s actually curable with appropriate treatment,” says Dr. Paul MacMullan, a rheumatologist and clinical assistant professor at the McCaig Institute for Bone and Joint Health at the University of Calgary. If you’re living with gout, here are some important steps to take to manage your condition.
Watch what you drink
Your healthcare provider will likely advise you to limit alcohol, especially wine and beer, to one drink a day for women and two a day for men. For Dr. MacMullan, sugary drinks like pop and energy drinks are as much if not more concerning and should be limited as well. “Sugary, high fructose corn syrup drinks are the worst [for gout].” Staying hydrated with water is also important. “Gout is caused by uric acid crystals, and you're more likely to develop crystals if you’re not well hydrated,” he explains. “Those crystal get deposited in and around joints and kick off an inflammatory cascade.”
Choose foods wisely
Healthcare providers also often recommend avoiding or limiting foods that are rich in compounds called purines , which raise uric acid levels. Purine-rich foods include red meat, organ meat (such as liver), oily fish (including sardines and mackerel), shellfish and foods that contain corn syrup, such as some barbecue sauces. Foods that may help reduce the risk of a gout attack include tart cherries, low-fat dairy, vitamin C (500 mg per day) and coffee (choose decaffeinated if you’re drinking more than two cups a day).
“We don’t prescribe exercise enough. [It’s like] a pill that can lower your blood pressure, improve your insulin metabolism, [help you] live longer, lose weight and make your mood happier,” says Dr. MacMullan, who recommends at least 30 minutes a day of physical activity. Why does exercise help manage gout? Because it combats other conditions. “We know that diabetes and high blood pressure are clearly associated with gout, and with worsening gout,” he says, adding that exercise also improves the body’s excretion of uric acid. Exercise also helps you manage your weight as excess weight is linked to a higher risk of gout.
Pay attention to your meds
Lifestyle changes make a big difference but working with your healthcare provider to find the right medication is also key. Allopurinol is one common example, which stops the liver from making uric acid (however, If you are of Thai, Korean or Chinese descent, you are at high risk for hypersensitivity to this medication. Your doctor should order a screening test and an alternate medication can be prescribed if needed). Dr. MacMullan cautions that a significant gout flare-up can be common when you first start your prescription, which can sometimes lead people to stop taking their medication. It’s important to discuss the possibility of a flare with your doctor, as they may recommend an additional prescription for a medication called colchicine. In addition, they may give an injection of a corticosteroid to help with any swollen, painful joints. Finally, your doctor may also suggest anti-inflammatory NSAID medication such as naproxen, as long as you don’t have other conditions, such as renal disease, diabetes or hypertension, which don’t mix well with those drugs.
Managing gout is a lifelong process, but it definitely can be done, and the payoff of fewer flares is definitely worth it! Learn more about Gout in our Arthritis Types section.