En español | Gout isn't just for paunchy Pickwickians who overindulge in Stilton cheese and a tawny port. More than 8 million Americans have this painful and potentially disabling form of arthritis, and that number is rising. Indeed, gout is now the most common type of inflammatory arthritis in men over age 40.
The notion that gout is no longer prevalent is just one of the many misconceptions swirling around this age-old malady. Below, experts replace several other myths with facts.
1. Myth: Only wealthy and obese people get gout.
Truth: People of all sizes get gout — although extra pounds increase the risk, says John Reveille, M.D., director of rheumatology at the University of Texas Health Science Center in Houston. Gout is also more common in people who have other, often weight-related health problems, including diabetes and high blood pressure or cholesterol. And while income has nothing to do with the condition, genes do play a part: If your parents had gout, you're more likely to have it as well.
2. Myth: Women aren't afflicted by gout.
Truth: Men and women alike can develop the disease, although men are more vulnerable earlier in life. "Gout is 10 times more common in men than in women, until women reach menopause. The incidence of new cases of gout in men and women tends to equal out after age 60 or so," says Herbert Baraf, M.D., clinical professor of medicine at George Washington University Medical Center in Washington, D.C.
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3. Myth: Gout pain always attacks the big toe.
Truth: Gout occurs when uric acid builds up in the blood, forming crystals that lodge in and inflame joints. It's true that gout often first attacks the joints of the big toe, but it can also occur in the knees, ankles, feet and hands. In women with osteoarthritis, for example, gout pain commonly starts in the small joints of the hands. Although the first attacks often involve only one or two joints, over time multiple joints become affected. If the disease isn't treated, it can cause permanent damage.
4. Myth: If you stay away from liver and alcohol, you'll avoid gout attacks.
Truth: Alcoholic drinks — especially beer — and organ meats such as liver and some fish, including anchovies and sardines, are very high in a class of natural substances known as purines. When the body breaks down purines it creates uric acid, so eating a lot of purine-rich foods does increase the risk of an attack. But while avoiding these foods may reduce attacks, it won't halt them, says Reveille.
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5. Myth: Gout is painful, but it won't kill you.
Truth: Gout can't kill you directly, but it can cause serious health problems that may eventually kill you, says Robert Keenan, M.D., assistant professor of medicine at Duke University. It can increase your risk of a heart attack or stroke, and it also may be linked to insulin resistance, the body's shrinking ability to use insulin to lower blood sugar. If gout is untreated, you can develop clumps of uric acid crystals called tophi, which can become infected and life threatening.
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6. Myth: There aren't effective medicines for gout.
Truth: Many medications put the brakes on gout. Some control pain and inflammation immediately and others get at the root cause by eliminating the deposited uric acid crystals.
Colchicine (Colcrys) is prescribed for acute gout flare-ups. A plant extract, it's been used to treat gout for 2,000 years, says Reveille. Colchicine works within several minutes to several hours to block gout inflammation. The sooner you start it, the more likely the attack will resolve quickly. An injected steroid also tackles inflammation, usually controlling pain and swelling within 24 hours.
Prescription drugs such as allopurinol (Lopurin, Zyloprim), febuxostat (Uloric) and probenecid (Benemid) all alleviate gout by controlling blood levels of uric acid. Also, two years ago the FDA approved an intravenous drug for people with advanced gout — pegloticase (Krystexxa) — that lowers uric acid levels and reduces deposits of uric acid crystals in the joints and soft tissue.
Most people who have gout will need to be on a uric-acid-lowering drug for life, usually just one or two pills a day, says George Washington University's Baraf.
7. Myth: Once you've got gout, lifestyle changes don't really help.
Truth: Lifestyle changes can reduce both the severity and frequency of attacks. For starters, when people lose weight, they often have fewer attacks, says Reveille.
Animal proteins have a higher level of purines, so it's better to eat vegetable proteins like beans and peas.
In fact, a 2010 review in the rheumatology journal Current Opinion in Rheumatology notes that protein-rich foods such as dairy products, nuts, beans, peas and whole grains are healthy choices for people with gout, reducing the risk of heart disease and possibly lowering the risk of insulin resistance.
Baraf says that he asks patients to abstain from alcohol during the first six months of treatment, until medications have stabilized uric acid levels. After that, he says, it's fine to drink — in moderation.
Dorothy Foltz-Gray is a freelance writer who lives in North Carolina.
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