What is Gout?

What is Gout

Gout is a painful form of inflammatory arthritis.1 Approximately 8.3 million Americans live with this disease.1 Gout usually appears first in the big toe, but can also affect the midfoot, ankles, knees, elbows, wrists and hands.2 In addition to swelling, gout can cause tenderness, redness and/or warmth in the affected joints, as well as lingering discomfort and limited range of motion.2,3 The condition happens when too much uric acid builds up in the body.2 Because the uric acid builds up over time, it may take months or even years for symptoms to arise.2

Initial attacks last between three to 10 days, and then months or years may go by before another attack occurs.4 Eventually, however, flares become more frequent and long-lasting.4 When this happens, patients may want to ask their doctors about how to help prevent gout flares. Preventive therapy may help ward off future attacks, which can help prevent damage to the joints.3,4

 

Who is likely to suffer from gout?

Gout remains a major and growing public health problem for many adult Americans—approximately six million men and two million women—it’s part of everyday life.1 Gout is more common in men than women until around age 60; experts believe natural estrogen protects women from the disease until they reach that age.5

 

Gout risk factors

A person is more likely to develop gout if he or she has a high level of uric acid in the blood.2 However, other factors may increase the likelihood of developing gout as well.6

Genes

For some people, gout is inherited.6 A 2009 study done at John Hopkins University on 12,000 people revealed a genetic cause for gout.7 Researchers uncovered a malfunctioning gene, which can lead to high concentrations of uric acid in the bloodstream.7

Health conditions

Pre-existing health conditions, such as high cholesterol, high blood pressure, diabetes and heart disease are associated with an increased risk of gout.6

Medications

Certain medications may increase the risk of gout. These include low-dose aspirin, diuretics (water pills) and immune-suppressing drugs.2

Diet

A person’s diet plays a major role when it comes to gout risk and prevention. Those who suffer from gout should avoid foods that are high in purines.8 Purines are chemical compounds found in some foods and drinks that the body breaks down into uric acid.8 Foods and drinks that are high in purines include6,8:

  • Red meat
  • Organ meats, including liver, kidney and sweetbreads
  • Certain types of seafood, including shellfish, anchovies, herring, sardines, mussels, scallops, trout, haddock, mackerel and tuna
  • Alcoholic beverages, especially beer
  • White breads, cakes, candy and products made with high-fructose corn syrup
  • Sugar-sweetened beverages

Drinking more water has been linked to fewer gout attacks.8 Eight to 16 eight-ounce glasses of fluid per day is recommended, with at least half of that being water.8 Talk with your doctor about appropriate fluid intake goals for you.8

Obesity

Obese people have a higher risk of gout and usually develop it at an earlier age.6 Gout risk increases as the body mass index goes up.2

Rapid weight loss

People who have undergone gastric bypass surgery are at a greater risk for gout.6 Crash diets and fasting also can trigger the disease.9

 

Stages of gout

According to the Arthritis Foundation, there are four stages of gout6:

  1. Asymptomatic hyperuricemia—Blood uric acid levels are higher than normal, but no symptoms are present.
  2. Acute gout, or a gout attack—Uric acid levels spike, triggering the gout attack. For most people, the attack happens during the night and intensifies over the next eight to 12 hours.
  3. Interval gout—The time between gout flares when there are no symptoms, but low-level inflammation may be damaging joints.
  4. Chronic gout—Attacks become more frequent and the pain does not subside as quickly as it once did. Joint damage may occur, which can lead to loss of mobility.

 

Symptoms of gout flares

At first, uric acid build-up in the blood may not cause any symptoms.6 When an attack occurs, however, the affected joint may become inflamed, swollen, red and intensely painful.2,3

 

Complications of gout

Most people who have had a gout attack will have another one between six months and two years later.2 Recurring attacks tend to last longer and affect more than one joint.2 If uric acid levels in the blood remain high, gout can become a chronic problem and help from a doctor may be necessary.

According to the Mayo Clinic, adults with gout can develop more severe conditions, including10:

  • Recurrent gout—When gout attacks occur several times each year. If left untreated, gout can cause erosion and destruction of joints.
  • Advanced gout—Untreated gout may cause tophi (TOE-fie) to develop under the skin. Tophi are deposits of urate crystals that can develop on the hands, feet, elbows or Achilles tendons. They are not usually painful, but can become swollen and tender during gout attacks.
  • Kidney stones—When urate crystals collect in the urinary tract, they can cause kidney stones.

 

How gout is diagnosed

Doctors are often able to detect gout based on its symptoms—a painful, red, swollen joint is a fairly sure sign.2

Arthrocentesis, a procedure in which the affected joint has fluid drawn from it, is needed for a more definite diagnosis.2 If the fluid drawn contains urate crystals, the gout diagnosis is positive.2

 

What to do if you suspect you have gout

If you think you have gout, visit your doctor and talk about the symptoms you are experiencing. You may want to download and complete the Gout Flare Questionnaire (from resources for patients) before your appointment.

If you are diagnosed with gout, your doctor will probably recommend lifestyle modifications and may prescribe medication.

 

NOTE:  This article was not written by a medical professional and is not intended to substitute the guidance of a physician. These are not West-Ward’s recommendations for gout flare prevention, but rather facts and data collected from various reliable medical sources. For a full list of resources and their attributing links, see below.

References

  1. Zhu Y et al. Prevalence of Gout and Hyperuricemia in the US General Population. The National Health and Nutrition Examination Survey 2007–2008. Arthritis Rheum. 2011;63(10):3136–3141.
  2. US National Library of Medicine. PubMed Health. Gout: Overview. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0073025/. Accessed November 16, 2017.
  3. Mayo Clinic. Diseases and Conditions. Gout. Symptoms. https://www.mayoclinic.org/diseases-conditions/gout/basics/symptoms/CON-20019400. Accessed November 16, 2017.
  4. National Institutes of Health. Gout. https://www.niams.nih.gov/health-topics/gout#tab-symptoms. Accessed November 16, 2017.
  5. Hak AE et al. Menopause, Postmenopausal Hormone Use and Risk of Incident Gout. Ann Rheum Dis. 2010;69(7):1305–1309.
  6. Arthritis Foundation. What is Gout? http://www.arthritis.org/about-arthritis/types/gout/what-is-gout.php. Accessed November 16, 2017.
  7. Johns Hopkins Medicine. Johns Hopkins Scientists Out a Gene for Gout. http://www.hopkinsmedicine.org/news/media/releases/johns_hopkins_scientists_out_a_gene_for_gout_. Accessed November 16, 2017.
  8. Mayo Clinic. Healthy Lifestyle. Nutrition and healthy eating. Gout diet: What’s allowed, what’s not. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/gout-diet/art-20048524. Accessed November 16, 2017.
  9. Arthritis Foundation. http://www.arthritis.org/about-arthritis/types/gout/causes.php. Accessed November 16, 2017.
  10. Mayo Clinic. Diseases and Conditions. Gout. Complications. https://www.mayoclinic.org/diseases-conditions/gout/basics/complications/con-20019400. Accessed November 16, 2017.

Important Safety Information for Mitigare® (colchicine) 0.6 mg capsules

  • Colchicine 0.6 mg capsules are contraindicated in patients with renal or hepatic impairment who are currently prescribed drugs that inhibit both P-gp and CYP3A4. Combining these dual inhibitors with colchicine in patients with renal or hepatic impairment has resulted in life-threatening or fatal colchicine toxicity. Patients with both renal and hepatic impairment should not be given Mitigare®.
  • Fatal overdoses have been reported with colchicine in adults and children. Keep Mitigare® out of the reach of children.
  • Blood dyscrasias such as myelosuppression, leukopenia, granulocytopenia, thrombocytopenia, and aplastic anemia have been reported with colchicine used in therapeutic doses.
  • Monitor for toxicity and if present consider temporary interruption or discontinuation of colchicine.
  • Drug interaction with dual P-gp and CYP3A4 inhibitors: Co-administration of colchicine with dual P-gp and CYP3A4 inhibitors has resulted in life-threatening interactions and death.
  • Neuromuscular toxicity and rhabdomyolysis may occur with chronic treatment with colchicine in therapeutic doses, especially in combination with other drugs known to cause this effect. Patients with impaired renal function and elderly patients (including those with normal renal and hepatic function) are at increased risk. Consider temporary interruption or discontinuation of Mitigare®.
  • The most commonly reported adverse reactions with colchicine are gastrointestinal symptoms, including diarrhea, nausea, vomiting, and abdominal pain.

Indication

Mitigare® is indicated for prophylaxis of gout flares in adults. The safety and effectiveness of Mitigare for acute treatment of gout flares during prophylaxis has not been studied.

Mitigare® is not an analgesic medication and should not be used to treat pain from other causes.

For Full Prescribing Information please CLICK HERE and for Medication Guide CLICK HERE.

You are encouraged to report negative side effects of prescription drugs to the FDA.

Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Manufactured by: West-Ward Pharmaceuticals Corp., Eatontown, NJ 07724

Important Safety Information for Mitigare® (colchicine) 0.6 mg capsules

  • Colchicine 0.6 mg capsules are contraindicated in patients with renal or hepatic impairment who are currently prescribed drugs that inhibit both P-gp and CYP3A4. Combining these dual inhibitors with colchicine in patients with renal or hepatic impairment has resulted in life-threatening or fatal colchicine toxicity. Patients with both renal and hepatic impairment should not be given Mitigare®.
  • Fatal overdoses have been reported with colchicine in adults and children. Keep Mitigare® out of the reach of children.