Gout is a painful joint condition caused by high levels of uric acid in the blood resulting in deposition of fine crystals in the joints. The most common presentation of gout is the sudden onset of intense pain, redness and swelling of the great toe joint at night or during sleep. The prevalence of gout has been steadily increasing over the past two decades is now estimated to be about 6 million in the U.S. Although gout is more common in men, the incidence of gout has doubled in women in recent years (1,2). The common causes of gout are dietary factors, overproduction of uric acid and kidney disease.  Known risk factors include male gender, a family history of gout, high protein diet, alcohol consumption, hypertension, metabolic syndrome, renal disease, obesity and diuretic use. Chronic high blood levels of uric acid (hyperuricemia) have been suspected to increase the risk of heart disease. Uric acid is biologically active and increases inflammatory mediators which cause damage to blood vessels, thus increasing heart disease risk (3).

Treatment for acute gout involves anti-inflammatory medications, steroid injections and/or joint aspiration and allopurinol for maintenance and prevention. A new medication, febuxostat, was recently approved by the FDA. In studies over a 5-year period, febuxostat reduced uric acid levels and almost completely eliminated gout flares (4). A study last year in Archives of Internal Medicine showed a 15% reduction in the incidence of gout with the intake of 500 mg per day of Vitamin C (2). A study at the Arthritis Research Centre of Canada in Vancouver found that long-term coffee consumption is associated with a lower risk of developing gout. Individuals who drank four or more cups of coffee per day had the least risk of developing gout (5).

The association between high uric acid levels and heart disease has been known for year, but until recently, the relationship was suspected to be more coincidental. Recent research suggests that uric acid may be a causative factor in heart disease involving a complex, multifaceted model. Uric acid has been shown to activate the immune response and the initiation of the inflammatory process is obvious to those who have experienced a red, hot, swollen, intensely painful great toe joint. Interestingly, uric acid has both antioxidant and pro-oxidant effects. Although uric acid may help quench free radicals and prevent oxidative damage to cells, it is also increases inflammatory mediators which can cause damage to blood vessels and increase heart disease risk (6).

Lifestyle and diet recommendation for those with gout include a combination of dietary changes and weight loss. Obesity increases the risk of gout. Obesity also increases the risk of hypertension (high blood pressure). Hypertension and some of the medications to treat hypertension both increase the risk of gout. Obesity is also associated with metabolic syndrome and metabolic syndrome has been linked to gout. A recent article in Current Opinion in Rheumatology outlined the following guidelines for those with gout, based on current research (7):

• daily exercise
• weight reduction
• limited intake of red meat
• avoid heavy alcohol consumption
• limited intake of sugary beverages
• Consider vitamin C supplementation
• Consume whole grains, nuts, legumes, fruits, vegetables
• Consume moderate amounts of lean white meats, low fat dairy and oily fish.
• Consider daily coffee intake. It is not recommended that those individuals who do not drink coffee should start drinking coffee.

1. Arthritis Rheum. 2010 Jan 21. DOI: 10.1002/art.27338
2. Arch Intern Med. 2009;169(5):502-507.
3. Curr Rheumatol Rep. 2010 Apr;12(2):118-24
4. Pharmacotherapy. 2010 Jun;30(6):594-608.
5. Arthritis Rheum. 2007 Jun;56(6):2049-55.
6. Rheumatology (Oxford). 2010 Jul;49(7):1229-38.
7. Curr Opin Rheumatol. 2010 Mar;22(2):165-72.

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