Gout is a lifelong condition marked by periods of calm followed by periods of flares. However, if treated appropriately, gout can be well controlled. Rheumatologist Erika Noss, MD, Ph.D., shares the questions her patients ask most about living with and treating gout. 1. Q: What’s going on in the bodies of people with gout? A: If you have gout, blood tests show that too much uric acid is building up in your body. This may be because your body is making too much uric acid, or because you’re not getting rid of enough uric acid through your kidneys. Uric acid is a byproduct of the purine turnover; purines are needed to form DNA in your cells. Any time your cells divide, get damaged, or breakdown, DNA is metabolized, creating uric acid. Interestingly, primates, including humans, are the only mammals that don’t have a natural way to get rid of excess uric acid. Almost all other mammals have an enzyme that breaks down uric acid. Why primates don’t have this enzyme is not known. Typically, uric acid is excreted by the kidneys, but when there’s too much uric acid in the blood, some of the uric acid will spill out and deposit in your tissues, especially joints. When this happens, the immune system identifies the uric acid as an intruder and will begin attacking it, causing inflammation and joint pain. When we are young, our kidneys tend to get rid of uric acid efficiently, but as people get older, especially if they have kidney disease or are overweight, the level of uric acid can rise and lead to gout. In some people, gout runs in the family. In these cases, there may also be genetic factors that lead to uric acid build-up. 2. Q: Which joints does gout affect? A: In the early stages of gout, symptoms usually appear in the big toe. It becomes very red, hot, swollen, and painful, and you won’t be able to walk on it. Sometimes the pain isn’t just in the big toe—it might be in your foot, ankle, or knees. Your first gout attack will be a painful, explosive experience. Seeking treatment right away will get the attack under control quickly, although early attacks will eventually get better on their own. As the uric acid continues to build up in your body, more joints become involved and nodules of uric acid, called tophi, can start appearing in the skin. Over time, without treatment, this can cause permanent joint damage. Fortunately, this damage is preventable with the right treatment. 3. Q: What are the risk factors for developing gout? A: Gout affects men earlier than women. In men, gout can begin to develop in the 20s, but it usually starts in the 30s and 40s. For women, there is something protective about estrogen. Gout in women who haven’t gone through menopause is extremely rare. After menopause, women develop gout at the same rate as men, and share the same risk factors: kidney disease, obesity, diabetes, high blood pressure, and high cholesterol. People who drink a lot of alcohol, especially beer, have a higher risk of gout, as are people who eat lots of red meat and sugary products made from high-fructose corn syrup. 4. Q: How is gout treated? A: We treat gout using two methods. First, when gout is in its early stages, we’ll prescribe medication to treat acute gout attacks as they occur. This medication is taken on an as-needed basis and is indicated for patients who only get a few gout attacks per year. Eventually, as time passes, you may begin to get gout attacks more frequently, so we’ll start you on a long-term control medication that you take daily. It lowers the levels of uric acid in your blood over time, preventing gout flares and easing joint pain. It’s very important that patients on these long-term medications commit to taking them every single day. If you stop and start them, you’re at a much higher risk of having a flare. If you don’t take it at all, your joints can be damaged permanently. 5. Q: Can you manage gout with lifestyle changes? A: It’s important that gout patients take their medication as prescribed while also making some lifestyle changes to stay in control of symptoms and prevent flares. The best lifestyle change patients can make is to lose 10 to 20 pounds, which can significantly lower uric acid levels. In addition, patients should eat a balanced diet, consume red meat and alcohol (especially beer) in moderation, and avoid drinks with high-fructose corn syrup (like non-diet soda). Some patients want to manage their gout only with diet changes. Since uric acid comes from purines in foods, purine-free diets have been tested to lower uric acid. These diets didn’t lower uric acid enough to control gout and most people found them unpalatable because the food has little taste. So going really crazy about trying to get all the purines out of your diet is not effective way to control gout. The better way to do this is to lose a little weight if you are overweight, stay away from large amounts of red meat, beer, and regular soda, and take your uric acid-lowering medication as prescribed.