John: “I Just Get Through It”
“I can’t tell you how much it hurts. And you wouldn’t believe me anyway. When the pain comes one night, you know that the battle is on and life goes on hold for a few days. My Dad had it too—I remember the old pair of sneakers with the hole cut out for his big toe. I call my doctor right away, and he gives me stuff for the pain. It helps, but nothing takes it all away.”
“I’ve had gout attacks for the past 4 years. Started when I turned 40 (the doctor said I was right on schedule). They usually only come once in awhile, but I’ve had 3 in the last 9 months. Bad luck I guess. What else can I do? At least it only happens once in awhile, it’s just in my toe, and I’ve learned how to deal with the pain.”
What John knows
- Gout attacks are one of the most painful medical conditions.
- A gout attack usually strikes suddenly, at night, and is most common in the large joint of the big toe.
- There may be a genetic link: many people with the condition have a family history of gout.
- Adult men, particularly those between the ages of 40 and 50, are more likely to develop gout.
- Treatment is available to help with the pain, and the sooner it is started after an attack the better it can work.
What John may not know
- Long-term treatments are available for gout.
- Over time, gout attacks can be more severe, last longer, and occur more often.
- Over time, gout may occur in more than one location for each person.
- Although 90% of people with gout have an attack in their big toe, other joints affected may be the instep, ankle, knee, wrist, and fingers.
- The pain of attacks is not the whole story—treating the attacks is not treating the underlying cause of gout: hyperuricemia.
- John is possibly at risk for joint destruction and other long-term health problems due to hyperuricemia associated with gout.
What John could do now
- Get the whole story about gout from his doctor.
- Make an appointment between attacks to talk about long-term treatment—not just managing the pain.
- See if his doctor recommends a serum uric acid test and a plan for lowering the amount of uric acid in his blood.
Andrea: “What Am I Doing Wrong?”
“I went to get something for the pain. But when my doctor looked at the lump on my knee she said it might not be just arthritis. She was right—it was gout. I’ve tried everything to control it—changing my diet, not drinking alcohol, taking medicine off and on, being more active … but I still had gout attacks.”
“I take a lot of pills for other problems, so my gout medicine sometimes gets lost in the shuffle—but I take it at least half the time. The attacks still come. In fact they have gotten worse—in my ankle as well as my knee! And as for diet, sometimes I eat steak or lobster and nothing happens. Other times I get an attack after being really “good” that day. A lot changed when I reached menopause. Gout is just another thing I’m going to have to face as I get older.”
What Andrea knows
- Long-term treatments are available for gout.
- Gout can cause tophi—crystal deposits made up of uric acid—to form around tissues of joints affected by gout.
- Most women who experience gout after menopause have other medical conditions and are taking medications for those conditions.
- Diet can affect gout, and eating too much of certain foods may play a role in triggering an attack.
What Andrea may not know
- Long-term gout treatment targets hyperuricemia—high uric acid levels in the blood; these levels decrease over time, not instantly with each dose of medication.
- Medication used to lower uric acid needs to be taken every day as directed—in fact, using such medicine inconsistently can trigger an attack.
- Diet is only one among many factors that can lead to an attack, and there’s often not a clear connection between specific things you eat and when an attack happens.
What Andrea could do now
- Talk to her doctor about her treatment plan and how it works for her gout.
- Talk to her doctor about how gout fits into her overall health picture.
- Ask about her serum uric acid level.
- Be honest with her doctor about how often she has taken her medication and her dietary habits.
Bill: “I’m Sticking to My Plan”
“I used to think of gout as something that happened to me once in a while—something I could forget about when it wasn’t there. Other than that, I’m healthy and fit. When I don’t have gout, I feel fine. But then my doctor explained hyperuricemia to me. She told me it was the underlying cause of gout and that it could be there even between the attacks if not properly treated. Over time, it also can potentially cause joint damage and kidney problems!”
“So I can put up with a diet and medication plan to lower the amount of uric acid in my blood. Then, soon after I started daily medication, I had an attack! But I kept taking it, and I’ve had fewer attacks since. My serum uric acid number is much lower. I’m taking active steps, and I feel like I’m more in control now.”
What Bill knows
- The underlying cause of gout is hyperuricemia—high uric acid levels in the blood.
- Complete treatment goes beyond the attacks because managing hyperuricemia is the most important factor in controlling gout.
- Reducing hyperuricemia may help reduce the number of attacks over time.
- Reducing hyperuricemia may help improve the signs and symptoms of health problems associated with gout over time.
- Diet can make a difference, but it is not the only factor and an attack is not caused by just one meal.
What Bill may not know
- Changes in uric acid level—even lowering uric acid—can cause attacks; but if the level is going down, that’s good news because it means the medication may be working.
What Bill could do now
- Follow his doctor’s advice carefully.
- Know that nothing can prevent all attacks, but maintaining a low uric acid level (in a healthy range) can reduce the risk of future attacks over time.
- Ask his doctor about how to keep fit and make other changes to improve his overall health.