I Have Gout, Now What?

PARAMUS, N.J. -- Hospital for Special Surgery rheumatologist Dee Dee Wu provides a broader understanding of gout and its treatments in part two of a two-part series. Part one can be found here.

Dr. Dee Dee Wu of Hospital for Special Surgery.
Dr. Dee Dee Wu of Hospital for Special Surgery. Photo Credit: HSS

How is gout diagnosed?

The diagnosis of gout is based on clinical history, physical findings of joint inflammation and most importantly, the identification of uric acid crystals in joint fluid obtained from the affected joint. X-rays of affected joints may show joint damage. However, uric acid level can be normal or low during an acute attack, so a normal uric acid level does not exclude the possibility of acute gout. Likewise, the presence of an elevated uric acid alone, in the absence of suggestive clinical symptoms, is not diagnostic of gout.

How is gout treated?

It is important to begin therapy quickly as the joint pain is often debilitating. Mild to moderate gout attacks can be managed with non-steroidal anti-inflammatories such as ibuprofen. Colchicine can be used for acute gout and also long-term for prevention of future gout. Oral or intravenous steroids, as well as local steroid injections into affected joints, can also quickly resolve joint inflammation.

Patients who suffer from frequent and severe gout attacks can be candidates for long-term therapy with allopurinol or Uloric. These medications lower the level of uric acid in the bloodstream, thus decreasing the risk of recurrent gout.

Are there useful lifestyle modifications that can be made to manage gout?

Several lifestyle modifications have been shown to be beneficial in preventing gout:

  • Dietary modifications, including restriction of purine-rich foods (i.e. red meat and shellfish), alcohol (especially beer) and fructose sweetened beverages.
  • Weight reduction in overweight patients has been shown to reduce both the development of gout and its recurrence.
  • There is suggestive evidence consumption of cherries can reduce the risk of recurrent gout, and that vitamin C intake can lower uric acid levels in the blood.

Dr. Dee Dee Wu is a rheumatologist at HSS, specializing in the treatment of rheumatoid arthritis, psoriatic arthritis, osteoarthritis, and osteoporosis. Dr. Wu currently practices at Hospital for Special Surgery’s Manhattan campus and the Paramus Outpatient Center.