Gout: causes, treatment and diet

What is gout?

Gout is a metabolic disorder caused by excessive levels of uric acid in the blood. This excess uric acid can form crystals that settle in the joints, leading to inflammation. This process – known as crystal deposition – is what triggers the painful gout attack.

Once the disease of kings

Gout was once known as the “disease of kings” because it was linked to excessive meat and alcohol consumption – luxuries only the wealthy could afford. “But gout can affect anyone,” says Dr Alexander Nydegger, a specialist in physical medicine and rehabilitation. “Anyone human, at least. Unlike many animals, humans have lost the ability to break down uric acid over the course of evolution, making us more prone to gout,” explains the Head Physician of Zollikerberg Rehaklinik.

Typical symptoms of a gout attack

High uric acid levels alone don’t always cause symptoms. “Many people have excess uric acid in their blood and have no symptoms at all,” Alexander Nydegger says. However, when it comes to the point of a gout attack, patients won’t forget the experience in a hurry: Intense pain, often at night, makes even the slightest touch excruciating. Typically, the joints furthest from the body’s core are most affected. “The further away, the cooler – and the easier it is for crystals to form,” Dr Nydegger explains. The big toe joint is particularly prone to inflammation.

Causes and triggers of gout

The exact cause of gout in each case is often not entirely clear. Nor is it understood why some people suffer painful attacks of gout while others don’t. But one thing is certain: The waste product, uric acid, plays a key role. And personal lifestyle choices can make a big difference – for better or worse.

Uric acid in focus

Uric acid is produced as a waste product of cell degradation, specifically when purines are broken down. It’s normally excreted via the kidneys, but if too much is produced or too little is excreted, the level of uric acid in the blood rises, increasing the risk of a gout attack.

Diet as a risk factor

Purines are also present in many foods, making them a potential gout trigger. They include red meat, offal, certain seafood and alcoholic drinks – especially beer. What’s particularly deceptive is that even supposedly healthy products – like juices containing fructose – can contribute to gout flare-ups.

Gout due to genetics and concomitant diseases

In addition to diet, genetic factors also play a role. “Some people find it more difficult to excrete uric acid,” Dr Nydegger explains. Gout also frequently occurs as a concomitant disease to blood cancer, as this causes cells to disintegrate in large numbers, resulting in the production of large quantities of uric acid. People with severe psoriasis can also develop gout in addition to their skin condition. “In such cases, even the best diet may not be enough,” Dr Nydegger acknowledges.

Diagnosis and important distinctions

The classic symptoms and the course of an attack often provide clear clues. Measuring the uric acid level in the blood will confirm the diagnosis – but this is done only after an acute attack has subsided, as the level is then typically lower. This is because during an attack, uric acid passes (in the form of crystals) from the blood into the joints.

A life-saving distinction

A gout attack can sometimes be mistaken for septic arthritis, a potentially life-threatening joint infection that usually causes high fever. “It’s crucial to distinguish between the two,” Dr Nydegger warns. “In cases that are difficult to determine, we take a fluid sample of the joint, examine it and send the patient to hospital. The key distinction is that a gout attack resolves in a few days, whereas septic arthritis can destroy the joint – and the patient may die.” Patients are therefore advised: If gout symptoms occur alongside fever, it’s best to be on the safe side and seek medical advice quickly.

Acute gout attack – what to do?

During a gout flare-up, the priority is to relieve the acute pain and inflammation. The basic steps:

When to see a doctor?

“Most patients automatically seek medical help for their first gout attack because the pain is so severe, and the painkillers that most people have at home, like Ibuprofen, aren’t enough,” Dr Nydegger explains. “However, to check uric acid levels, patients need to return at a later date, as the readings are usually lower during an attack.”

Long-term treatment of gout

Once gout is diagnosed, the goal is to find a way to lower uric acid levels in the long term. Making dietary changes is an important part of the process.

Diet as the key to controlling gout

Overindulging in meat at a "Metzgete”, drinking lots of beer, and then standing outside in the cold – smoking, perhaps – is a classic combination of factors to trigger an attack in gout patients. But it doesn’t always take that much and varies from person to person. As a general rule: Avoid high-purine foods such as red meat, offal and alcohol (especially beer and spirits). Fructose-rich products, like fruit juices and some ‘light’ fruit yoghurts are also risky, as they can promote uric acid formation too.

Foods that help

By contrast, dairy products help reduce the risk of gout attacks, our expert says. “There’s also evidence that vitamin C and coffee can offer some protection, though this varies between individuals and shouldn’t be seen as an excuse to overdo it with coffee or vitamin supplements,” Alexander Nydegger adds. People who suffer frequent gout attacks are advised to consult a professional nutritionist who will help identify personal risk factors and propose dietary changes.

Medication to lower uric acid

To manage more severe gout in the long term, medication is needed alongside new dietary habits. The good news: The most commonly prescribed drug, allopurinol, achieves results for most patients, as it reduces uric acid production.

Side effects

The bad news: Things get distinctly more difficult for gout patients with a kidney condition, as allopurinol aggravates the condition. An alternative medication, febuxostat, is better tolerated by those with mild kidney insufficiency, though it’s significantly more expensive. Another option is uricosuric medication, which promotes uric acid excretion – but this, too, can create difficulties for kidney patients. Some other drugs are either not approved in Switzerland, staggeringly expensive, reserved for specific patient groups such as cancer patients, or difficult to administer.

Current research

Research and development are being conducted along various lines, but progress has been limited. “Patients with gout and kidney disease really drew the short straw – they’re sadly much harder to treat,” Dr Nydegger notes. “And even in patients without kidney problems, we sometimes see such severe forms of gout that we can hardly find a remedy that helps. Thankfully, these are isolated cases, and we do everything we can to provide them with the best possible relief too.”

Conclusion – gout is usually manageable

It’s important to know that gout isn't a sign of weakness or personal failure – it’s a medical condition that can affect anyone. “Patients should be aware that effective medications are available to treat gout. With the right diet, medication and good medical support, most people can manage the disease well,” Alexander Nydegger concludes.