Gout is an excruciatingly painful form of arthritis—so painful that most patients can’t even bear the weight of a bedsheet on the tender joint. Its throbbing pain strikes abruptly, often at night, turning the skin red-hot and leaving the affected joint swollen and tender for 5 to 10 days. Gout is the most prevalent form of inflammatory arthritis. It occurs 7 to 9 times more often in men than women—each year striking an estimated 3.4 million American men older than age 40.
Gout is caused by excessive levels of uric acid, a waste product from body tissues. We all have uric acid in our blood, which is normally excreted in the urine. If you experience gout, you either produce too much uric acid or your kidneys don’t excrete enough—the cause of about 90% all cases. And, the excess uric acid turns into tiny, needlelike crystals that collect in joints, causing intense inflammation, swelling, and pain.
In most cases gout strikes one joint, and 50% of the time the big toe is the prime target. Other frequent sites include the forefoot, instep, heel, ankle, and knee. While almost any joint can become a sore point, gout is uncommon in the upper body. Although only one small joint may be affected, the inflammation can be intense enough to cause fever, muscle aches, and other flulike symptoms. To minimize pain and promote healing, heed these gout treatment do’s and don’ts from the experts.
Get some R and R
During an acute attack of gout, be sure to rest and elevate the inflamed joint. You’ll probably have little trouble following this advice to the letter because the pain will be so intense.
Reach for ibuprofen at the first sign of pain
It is the tremendous inflammation around the affected joint that causes the pain. So when you need a painkiller, make sure it’s one that can reduce inflammation—namely ibuprofen, says Jeffrey R. Lisse, MD. Follow label instructions. If those dosages don’t give relief, he says, consult your doctor before increasing them.
MORE: 6 Things Your Joint Pain Is Trying To Tell You
Avoid aspirin or acetaminophen
When it comes to gout treatment, all pain relievers are not created equal. Aspirin can actually make gout worse by inhibiting excretion of uric acid, says Lisse, and acetaminophen doesn’t have enough inflammation-fighting capability to do much good. (Make sure to avoid these 13 pain medication mistakes.)
Skip sugary soda
In a 12-year Canadian study of men with no history of gout, University of British Columbia researchers found that men who drank 2 or more sugary sodas or other fructose-loaded soft drinks each day increased their risked of gout by 85% compared with men who drank one serving or less per month. Even moderate intake—5 or 6 soft drinks a week—increased the risk significantly. If you must have your soda fix, drink the diet version, which doesn’t increase the risk of gout (but be weary).
Apply ice
If the affected joint is not too tender to touch, try applying a crushed-ice pack, says John Abruzzo, MD. The ice has a soothing, numbing effect. Place the pack on the painful joint for about 10 minutes. Cushion it with a towel or sponge. Reapply as needed.
Drink lots of water
Large amounts of fluid can help flush excess uric acid from your system before it can do any harm. Uric acid levels are typically elevated for 20 to 30 years before they cause any trouble. For best results, drink 5 or 6 glasses of water a day. As a bonus, lots of water may also help discourage the kidney stones that can affect people with gout. (Need encouragement? Try these 25 sassy water recipes.)
Consider herbal teas
Another good way to take in sufficient liquid is with herb teas. They’re free of both caffeine and calories, so large amounts won’t make you jittery or pile on unwanted pounds. Eleonore Blaurock-Busch, PhD, especially recommends sarsaparilla, yarrow, rose hip, and peppermint teas. Place 2 tablespoons of the dried herb in a pint of boiling water. Steep for 10 to 20 minutes, then strain before drinking.
Avoid high-purine foods
“Foods that are high in a substance called purine contribute to higher levels of uric acid,” says Robert Wortmann, MD. Therefore, avoiding such foods is prudent. Those foods most likely to induce gout contain anywhere from 150 to 1,000 milligrams of purine in each 3 1/2-ounce serving. They include high-protein animal and fish products such as anchovies, brains, consommé, gravy, heart, herring, kidney, liver, meat extracts, meat-containing mincemeat, mussels, sardines, and sweetbreads.
Limit other purine-containing foods
Foods that may contribute to gout have a moderate amount of purines (from 50 to 150 milligrams in 3 1/2 ounces). Limiting them to one serving daily is necessary for those with severe cases. These foods include asparagus, dry beans, cauliflower, lentils, mushrooms, oatmeal, dry peas, shellfish, spinach, whole grain cereals, whole grain breads, and yeast. In the same category are fish, meat, and poultry. Limit them to one 3-ounce serving 5 days a week.
Sip coffee
The risk of gout was 40% lower for men who drank 4 to 5 cups of java a day, and 59% lower for men who drank 6 or more a day than for men who didn’t drink coffee, according to a Harvard University study of 45,869 men older than age 40 with no history of gout. “Coffee consumption is associated with lower serum uric acid levels, but tea consumption is not,” says lead researcher Hyon K. Choi, MD, DrPH. He speculates that components in coffee, other than caffeine, may be responsible for the beverage’s gout-prevention benefits. Among those possibilities is phenol chlorogenic acid, a strong antioxidant.
Skip beer
Drinking two 12-ounce beers a day increases the risk of gout more than twofold, while consuming two drinks with hard liquor raises the risk 1.6 times, according to a follow-up study of 47,000 men from the Harvard School of Public Health. Drinking wine showed no influence. “Individuals with gout should try to limit or even cut out their beer consumption, but wine is allowed,” says Choi.
Control your blood pressure
If you have high blood pressure and gout, you have double trouble. Certain drugs prescribed to lower blood pressure, such as diuretics, actually raise uric acid levels, says Branton Lachman, PharmD, JD. So taking steps to lower your blood pressure naturally is wise. Try decreasing your sodium intake, losing excess weight, and exercising. But never discontinue any prescribed medication without consulting your doctor. (Try these foods that lower blood pressure.)
Lose 10 pounds and keep it off
In a 12-year study of 47,150 men with no history of gout, Massachusetts General Hospital researchers found that men who lost 10 pounds and kept it off reduced their risk of gout by 39%. (Here are 50 ways to lose 10 pounds.)
Beware of fad diets
The same study showed that being overweight increases your risk of developing gout. Heavier people tend to have high uric acid levels. But stay away from fad diets, which are notorious for triggering gout attacks, says Lisse. Such diets—including fasting—cause cells to break down and release uric acid. So work with your doctor to devise a gradual weight-loss program.
Get enough calcium
If you’re a man older than 40 with a family history of gout, aim for 1,000 milligrams of calcium a day. That much daily calcium reduced the risk of gout 40% in a group of 48,000 men studied for 12 years, according to the American College of Rheumatology.
MORE: 10 Dairy-Free Ways To Get More Calcium
Consult your doctor about supplements
Be careful when taking vitamins, says Blaurock-Busch, because too much of certain nutrients can make gout worse. Excess niacin and vitamin A, in particular, may bring on an attack, she says. So always consult a physician before increasing your vitamin intake.
Don't hurt yourself
For some unknown reason, gout often strikes a joint that’s been previously traumatized. “So try not to stub your toe or otherwise injure yourself,” says Abruzzo. “And don’t wear tight shoes, which can also predispose your joints to minor injury.”
Gout cures from the kitchen
Cherries have long been a folk remedy for gout. Now there is scientific evidence that eating cherries lowers uric acid levels. In a small study, 10 women ate about 1 1/2 cups of cherries after an overnight fast. Researchers found that plasma levels of urate, found in uric acid, fell significantly over a 5-hour period after the cherries were eaten. Although there is no hard scientific evidence that cherries help relieve gout, many people find them beneficial. If you are lucky enough to have fresh cherries, eating about a half dozen daily may relieve the symptoms of gout.
When you feel an attack coming on, eat 20 to 30 cherries immediately. It doesn’t seem to matter whether they are sweet or sour varieties or whether the cherries are canned, frozen, or fresh. Reported amounts vary from a handful (about 10 cherries) a day up to 1/2 pound. You can also try natural, concentrated black cherry juice and drink several tablespoons of the concentrate daily until the pain is relieved. People have also reported success with 1 tablespoon of cherry concentrate a day, says Agatha Thrash, MD.
When To Visit A Doctor For Gout
If you experience sudden and intense pain in a joint, call your doctor. Even if the pain goes away in a day or two, it is important to see your doctor, because gout left untreated can lead to more pain and joint damage. Your doctor may prescribe a number of prescription medications to help reduce inflammation and relieve pain during a gout attack, including corticosteroids such as prednisone. Once an attack has passed, your doctor may prescribe a medication to lower your uric acid in an attempt to prevent future attacks. You also may receive colchicine, a medicine used for thousands of years to handle gout, sold under the names Allopurinol and Probenecid.
Panel Of Advisors
John Abruzzo, MD, is director of the division of rheumatology and a professor of medicine at Thomas Jefferson University in Philadelphia.
Eleonore Blaurock-Busch, PhD, is associate laboratory director of King James Medical Laboratory and Trace Minerals International, both in Cleveland. She is also the director of Micro Trace Minerals in Hersbruck, Germany; cochair of the International Association of Trace Elements and Cancer; and author of several books.
Hyon K. Choi, MD, DrPH, is an epidemiologist and rheumatologist at Massachusetts General Hospital in Boston.
Branton Lachman, Pharm.D, JD, is a practicing attorney and consultant pharmacist in Corona, California. He has also taught at the University of Southern California School of Pharmacy, Western State College of Law, Southern California Law School, and the California Public School System.
Jeffrey R. Lisse, MD, is a professor of medicine, head of clinical osteoporosis research, and associate chief of the Arthritis Center at the University of Arizona in Tucson.
Agatha Thrash, MD, is a pathologist who lectures worldwide. She is also cofounder of Uchee Pines Institute, a nonprofit health-training center in Seale, Alabama, and author of many books.
Robert Wortmann, MD, is a professor of medicine at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire.
