Gout is a chronic condition that causes attacks of severe joint pain and inflammation. Unfortunately, it can sometimes be poorly treated because patients don’t always have a thorough understanding of what causes gout. Gout occurs when there’s too much uric acid in the blood, which happens because the body produces too much uric acid, or the kidneys don’t process uric acid efficiently. When uric acid builds up in the blood, some of it travels from the blood to affect the joints. When that happens, the immune system perceives the uric acid as an invader and starts attacking the joints, causing inflammation and pain. Gout is caused by a combination of genetics, unhealthy diets, excessive alcohol consumption, obesity, and kidney disease. It can be a challenging condition to live with, but fortunately, with the right education and treatment, patients can reverse the process. Gout patients should seek the care of a rheumatologist, a doctor who specializes in treating conditions affecting the joints and muscles. There are many things to keep in mind when treating gout—here’s what I want my patients to know. 1. Develop a trusting relationship with your rheumatologist. Gout is a long-term condition, so it’s imperative to build a strong partnership with your rheumatologist. The key to gout treatment is education. I always try to educate my patients as much as possible about what causes gout, so they can understand why I’m giving them specific advice and they can feel empowered to make informed decisions with me. 2. Be patient. Treatment works, but it takes time. When gout first affects someone, it’s typically a painful, explosive experience. These are called gout attacks or flare-ups. We choose the right treatment plan based on how many attacks you experience and how severe they are. For most people, gout attacks will occur a few times a year at first, but then increase in frequency as time passes. We divide gout treatment into two “bins.” There’s treatment that immediately relieves a gout attack, like when you wake up with a hot, red, swollen joint. That medication is taken as needed. Once attacks become more frequent, there’s treatment you take every day to prevent attacks from occurring in the first place. This treatment is taken daily and it works by lowering the amount of uric acid your body produces. With the right medictions, gout is very treatable, although getting on a effective treatment plan can take time. Fortunately, in many cases, patients find a doctor they trust and get on medications that work. But often, gout goes undiagnosed, or patients have more urgent health conditions to treat, so they can go years without getting control of it. Eventually, when enough uric acid builds up in your body, this can cause permanent damage to your joints. That’s why it’s so important to stay dedicated to finding the treatment plan that works for you—it might take a while, but once you’re on the right therapies, you’ll be able to prevent long-term damage to the joints and, for the most part, live without symptoms. 3. Track your flare-ups and keep your doctor informed. One of the real challenges with gout is that at first, patients only have attacks intermittently. Their gout is often ‘out of sight, out of mind.’ I stress to my patients that, if we don’t start the daily therapy right away to lower uric acid, they need to pay attention to how many gout attacks they’re getting. If the number of attacks increases to more than one or two yearly, it’s time to start a regular medication to lower uric acid rather than take just an as-needed option to treat gout attacks. If you’re starting to get more than just a few gout attacks a year, if your attacks last for a long time, or if multiple joints are affected, a chronic uric acid-lowering therapy will be a good idea for you. I also encourage regular follow-up appointments. I try to see my patients at least once or twice a year so I can keep track of the number of gout attacks they are having and track the uric acid level in their blood. I want to know if the medication they’re on is working or if we need to make an adjustment. 4. Commit to your treatment plan. It’s imperative people with gout take their medications exactly as prescribed. When you have an acute gout attack, make sure you continue taking the as-needed medications that treat the attack until your symptoms have been gone for two days; otherwise, the gout may just come right back. Once you get to the point where you’re on a daily medication, you must stay on that medication. The worst thing you can do is stop and start this chronic, uric acid-lowering medication, because when your uric acid levels go up or down, that increases your risk for a flare. I want patients to know that starting uric acid lowering therapy may be rocky initially, as it can increase the chance of gout attacks. But ultimately, if you stick with your medication, your symptoms and gout control will get much better. When patients first start the daily medications, they’re actually at an increased risk of attacks—but if they know this and keep me updated, we can get through the initial adjustment period. I understand it can be difficult to stay committed to the medication, because this long-term treatment doesn’t show immediate results. It’s one thing to take a medication and feel better right away—there’s clear incentive to take it in that case. But with the daily medications, you’re taking them to prevent gout attacks and joint damage over the long term. It is a much harder committment. Do your best to take your medications as prescribed, because you’ll do much better in the long run if you stay consistent. 5. Eat well and maintain a healthy weight. Gout is closely connected with lifestyle habits. It’s really important to eat well and avoid foods that increase your uric acid. Alcohol, red meat, sugary drinks, and products with a lot of high fructose corn syrup are notorious for causing gout attacks. Eat a balanced diet full of lean meats, protein, fiber, fruits, and veggies, and your gout will be better controlled. It’s also important to maintain a healthy weight, as weight gain increases the amount of uric acid in your blood. The bottom line with gout is it’s possible to get in control with patience, education, and commitment. Work with your rheumatologist to find a treatment plan and take an active role in your care so you understand how to best manage your disease.