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7 Myths About Gout

Get the facts on gout symptoms, causes and treatments

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.

Large man, Gout Myths and Facts

People of all sizes and incomes get gout. — Photo by Getty Images

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.

Next: Is it true that women aren't afflicted by gout? »

2. Myth: Women don’t get gout. Truth: Older women are also vulnerable. “Gout is ten 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.”  That’s because with the loss of estrogen, uric acid rises. Gout’s also more common in people who eat and drink too much, or those who have other health problems like diabetes, high blood pressure or cholesterol. Genes also play a part: If your parents had gout, you’re more likely to as well. For 8 Myths about Gout slideshow.

Gout is not a gender-specific disease. — Photo by Corbis

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 starts in the big toe Truth: It’s true that gout often first attacks the joints of the big toe, but that’s not always the case. In women with osteoarthritis, for example, gout pain commonly starts in the small joints of the hands. Although the first attacks often involves only one or two joints, over time multiple joints become affected. If the disease isn’t treated, it can cause permanent damage. For 8 Myths About Gout slideshow.

Throbbing pain on the tip of your big toe? You might have gout. — Photo by Veronique Beranger/Getty Images

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.


6. Myth: To sidestep gout, you only need to avoid liver and alcohol.  Truth:   Liver and other organ meats, alcohol— especially beer—and some fish like sardines and anchovies are high-purine culprits. And high levels of purines increase uric acid levels, upping the risk of a gout attack. Cutting back on these foods and drinks may reduce but not halt attacks, says Reveille.  Alcohol carries a double whammy: it increases uric acid levels, and also interferes with uric acid excretion. “I ask my patients to avoid alcohol during the first six months of treatment,” says Baraf. Once the arthritis and uric acid levels are controlled, you can have anything to eat or drink in moderation.  Most people will need to be on uric acid lowering medication for life, usually just one pill a day, says Baraf. For the 8 Myths About Gout slideshow.

Avoiding alcohol may reduce your chance of getting gout attacks. — Photo by Lew Robertson/Corbis

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.

Next: Can gout kill you? »

. Myth: Gout is painful, but it can’t kill you.   Truth: “Gout can’t kill you directly, but it can cause problems,” says Keenan. “It can increase cardiovascular risk and is linked to metabolic syndrome” —a group of risk factors like high cholesterol and body fats and high blood pressure—which raises the risk of heart disease, stroke, and diabetes. Gout 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. For the 8 Myths About Gout slideshow.

Gout can be life threatening if left untreated. — Photo by Corbis

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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4. Myth: There’s no way to treat it.  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], a plant extract, for acute gout flare-ups, treats the pain and inflammation.  “It’s been used to treat gout for about 2000 years,” says John D. Reveille, M.D., director of the division of Rheumatology and Clinical Immunogenetics at the University of Texas Health Science Center in Houston. Prescription drugs such as Allopurinol (Lopurin, Zyloprin), febuxostat (Uloric) and Probenecid (Benemid) all help alleviate gout by controlling blood levels of uric acid.  Two years ago the FDA approved a new intravenous drug for people with advanced gout, pegloticase (Krystexxa), which lowers uric acid levels and reduces deposits of uric acid crystals in the joints and soft tissue. For the 8 Myths About Gout slideshow.

There are prescription drugs that can treat gout. — Photo by Getty Images

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: People with gout should avoid all proteins. Truth: Animal proteins have the highest levels of purines, so it’s better to eat vegetable protein like beans and peas, which may also help you lose weight.   In fact, a 2010 review in a rheumatology journal notes that protein rich foods like 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. For the 8 Myths About Gout slideshow.

Changing your diet can help reduce the frequency of gout attacks. — Photo by Getty Images

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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