Gout: The Top 10 Questions

1 Does gout go away?

Gout is the accumulation of uric acid around the joints and in the surrounding tissues over several years. Gout attacks are usually mild at first and then gradually increases in severity over time. During a gout attack, the involved joints become red, swollen, warm, and painful. These symptoms will eventually go away in one weeks’ time.

If you have a mild gout attack, the symptoms will disappear within a few hours, but sometimes, it can even go on for a day or two. Moreover, severe gout attacks can last for a longer period of time, extending up to several months in a year.

Many people usually develop a second attack of gout after about six months to two years following the first attack. There can be a gap of a symptom-free period of several years between two attacks. So does gout go away? Yes, it usually goes away, but it can come back after six months to two years. You may also remain symptom-free for even a longer time than this. However, if you continue to delay the treatment of gout, the frequency of gouty episodes may increase. Thus, gout temporarily goes away. For it to be completely gone, you have to get treated for it.

2 Does gout cause skin peeling?

Yes, skin peeling is a common symptom of gout. Gout can cause skin peeling that looks similar to a sunburn. Skin peeling is due to the damage of the underlying tissues over the affected joints. The condition can make the skin around the joints become stretched, red, and itchy. In some instances, due to the extensive skin peeling, bleeding can also occur as a result of the cracked skin. It is usually the result of severe swelling of the skin that surrounds the affected joint. Therefore, keep in touch with your health care provider if the symptoms of skin peeling become so severe to the point of bleeding.

3 What can you do to alleviate gout symptoms?

Gout attacks can be so severe that it would even wake you up during the wee hours of the night. So if that is the case, what should you do? Here are a few things you can do to relieve the pain of gout attacks.

• Take medicines that you have been prescribed for gout - They can be over-the-counter painkillers such as ibuprofen or naproxen to immediately relieve the pain. However, DO NOT take aspirin as it can make the condition worse. If you have been already prescribed with drugs for gout such as uric acid lowering drugs, then you should take them immediately as well.

• Apply some ice over the affected joint - Aside from taking painkillers, you can place some ice packs over the affected joint to control the pain. Using ice packs can also help you to reduce the inflammation around the affected joint.

• Stay hydrated - Drink lots of water throughout the day. Drinking the recommended amount of water is important to flush out the excessive uric acid in your body. It also helps to prevent the formation of kidney stones, which is another common problem when you have high levels of uric acid.

• Stay away from alcohol - Alcoholic drinks such as beer has a high amount of purines. Purines are organic compounds that are usually metabolized to produce uric acid. Therefore, drinking too much alcohol will increase the production of uric acid in your body, and thus, will predispose your gouty attacks. Furthermore, alcohol also prevents the excretion of uric acid from the body.

• Inform your doctor right away during an attack - It is important to call up your doctor immediately when you have a gout attack. Your doctor may prescribe you new drugs to control the pain.

• Keep the affected leg elevated to bring down the swelling.

• Walk with the use of an aid - Do not apply too much pressure on the affected joint. Hence, use a walking aid such as a cane to help you walk without exerting much pressure.

• Relax - Avoid all stressors in your life or practice measures that will keep you relaxed. This is an important action to control stress because stress may aggravate your condition.

• Avoid eating purine-rich foods such as red meat, shellfish, or sweetbread.

4 Can gout be cured?

Yes, with the proper treatment and compliance by the patients, gout can be treated. Gout is the accumulation of excessive uric acid crystals in the joints. With treatment, the formation of new uric acid crystals is prevented and dissolves the existing uric acid crystals. Once all the excessive uric acid crystals are gone, gout is said to be cured.

There are two main strategies used to help lower the uric acid levels. They are:

• Changes to one's lifestyle such as change in the diet and losing weight

Losing weight, limiting the consumption of alcohol, and avoiding purine-rich foods such as red meat and dark fish all help to reduce the uric acid levels in the body. Research have proved that certain foods such as dairy products like low-fat yogurt and skimmed milk and cherries reduce the levels of uric acid in the body.

• Long-term drug treatment for gout

Long-term drug treatment for gout is only initiated once the symptoms of an acute gouty arthritis attack are completely alleviated. The long-term use of such drugs aims at reducing the levels of uric acid. They prevent the formation of new uric acid crystals as well as reduce the existing uric acid crystals. The most commonly used drug in the treatment of gout is allopurinol. It reduces the amount of uric acid production in the body. Other drugs used in the long-term management of gout include sulphinpyrazone and benzbromarone. These drugs mainly increase the excretion of uric acid from your body. Usually, once these drugs are started, the immediate dissolution of some of the uric acid crystals may also cause an acute gouty attack. Therefore, along with the abovementioned drugs, anti-inflammatory drugs or colchicine may be prescribed in the first 3-6 months to alleviate the pain.

Allopurinol is often started with a small dose and then slowly increased to the right dose that is effective for you. This slow change of the allopurinol dose causes a slow reduction in the uric acid levels, thereby minimizing the chances of getting an acute attack of gout.

5 What is acute gouty arthritis?

Acute gouty arthritis is one of the most painful types of arthritis. It is a form of arthritis that results from the accumulation of uric acid crystals. A typical attack is characterized by severe pain, swelling, redness, and warmth of the joint. The big toe is the most commonly affected joint and is called as podagra. However, any other joint can be affected as well. Usually, an acute attack of gout will reach its peak about 12-24 hours after its onset and will resolve on its own without any treatment. It will take about 7-14 days for an acute attack of gout to resolve without treatment.

Since acute gouty arthritis is a very painful condition, most patients need painkillers in their treatment. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and diclofenac are commonly used to relieve such pain. The most effective treatment for an acute attack of gout is to withdraw some of the fluid that has accumulated within the joint or through the injection of steroids into the affected joint. Applying ice packs to the area is also helpful in relieving the inflammation and pain.

6 What happens in your body when you have gout?

Gout happens when there are excessive amounts of uric acid in the blood and tissues. Uric acid or urate levels in the body can increase in any of the following ways:

• Reduced excretion of uric acid or urate – Uric acid is excreted via the kidneys and a reduced excretion of uric acid through the kidneys is the most common cause of hyperuricemia. It could also be a hereditary condition. The condition is also seen in patients who need diuretics and people with conditions that affect the kidneys.  
• Increased production of uric acid or urate
• Increased consumption of purine-rich foods such as mushrooms, liver, asparagus, sardines, and sweetbread

When the uric acid content within the tissues gets saturated, these urate salts start to precipitate and produce crystals. These uric acid crystals precipitate in the form of needle-like crystals.

7 Should you exercise if you have gout?

Just thinking about getting up and moving about alone are difficult things to do in the midst of an acute and painful gouty attack. Thus, exercising is not something to be anywhere in your mind. However, exercising is really good if you are suffering from gout. If you stay away from exercise, it will only make your gout worse. Inactivity will make you less flexible, which will lead to the weakening of your muscles and joints, making the symptoms of gout worse. Moreover, if you regularly exercise, you will be able to maintain a healthy weight and achieve a faster recovery.

8 How long does gout last if not treated?

Usually, most gout attacks resolve on their own even without any treatment and most of them disappear after about a week. The length of the attack depends on the severity of the condition. If you have a mild attack, then the symptoms will disappear after several hours or after one or two days. However, if you happen to have a severe attack, it may take about several weeks to one month for the symptoms to go away.

If you leave your gout untreated, the frequency of these attacks will increase with time. Therefore, take the prescribed medications as early as possible to avoid painful attacks in the future.

9 What foods are high in purines?

Purines are specific chemical compounds that are found in the body and are broken down to produce uric acid. That is why consuming purine-rich foods will raise the uric acid levels in your body and may lead to gout. The foods that are high in purines are:

• beef, pork, and lamb meat
• animal organ meat such as the kidney, liver, and brain
• beer
• sardines
• mackerel
• tuna
• gravy
• high-purine vegetables such as asparagus, spinach, mushroom, and cauliflower

So then what is good for you to eat? You can eat foods that are low in purine. The following are low-purine foods that are easy for you to eat:

• green vegetables
• dairy products such as low-fat or nonfat milk and low-fat yogurt
• fruits
• chocolate
• bread and cereals
• coffee, tea, and carbonated drinks
• peanut butter

10 Is ice good for gout?

Ice is a really good pain reliever for gout. Applying ice to the affected joints is one of the most commonly used treatment methods for gout. You can apply an ice pack over the affected joints several times a day for about 20-30 minutes. This will help you relieve the pain caused by acute gout attacks. However, it only gives you a short-term relief. Therefore, you will still need painkillers to reduce the pain completely. Ice not only reduces the pain, but it also reduces the inflammation around the joint that contributes to the pain. 

On the other hand, it is known that uric acid crystals easily form in lower temperatures. Hence, if you use an ice pack to relieve pain over the joint, it lowers the temperature in that area, thereby predisposing the formation of uric acid crystals. Knowing this information, you would not want to apply ice packs during gout attacks. Ice is not the only available method of pain relief. There are many other choices that are more effective that just applying ice. Therefore, it is better to avoid applying ice to the affected area and keep the joint warm. Use other methods to relieve one's gout pain instead of ice.