In mainstream medicine, we tend to treat gout flares only without taking the patient’s overall health into consideration. In this article, we’ll discuss our approach to gout.
It affects enough people that it’s part of the health screening process here at Digital Nomad Health.
Gout Arthritis
Gout often presents as inflammation of a joint. Often the skin is quite sensitive to the touch; there is swelling, pain at rest, and severe pain with movement.
Elevated uric acid is at the heart of gout, which primary care physicians may not adequately manage.
Treating gout flares alone may not decrease the overall disease risk that is associated with elevated uric acid levels. Almost all patients will have high uric acid, even if that is not flagged on the lab results.
Lifestyle Modifications for Gout Treatment
Any lifestyle change is a herculean task for patients to achieve. The reasons are complex, but it concerns our upbringing and barriers to change.
The interventions that seem to be quite effective are:
1. Obesity Reduction
For various reasons, including changes in uric acid removal by the kidneys, obesity seems to complicate gout matters.
Losing weight or changing the ratio of muscle mass to fatty tissue can be quite effective. There are effective strategies to improve body composition.
2. Dietary Changes
Purine-rich foods tend to elevate uric acid levels, which can lead to gout flares. Fructose and processed carbohydrates are perhaps the biggest culprits.
Alcohol is a factor to consider as well. However, most people consume little alcohol and may not benefit from drastic changes in alcohol consumption.
3. Exercise
Unfortunately, there is a dearth of studies on the relationship between exercise and gout. However, anecdotally it’s safe to say that moderate activity levels will help with uric acid clearance.
Loweing Uric Acid Levels
Because elevated uric acid increases the risk of hypertension, all-cause mortality, and cardiovascular disease, it’s important to lower it.
If lifestyle modification alone isn’t enough to lower uric acid levels, the next step would be to prescribe medications to lower it.
Fortunately, medications such as allopurinol are well-tolerated for gout treatment. Other options are also available, but this is often the agent we start with.
We may try febuxostat if allopurinol fails. The goal is to be rather aggressive with uric acid lowering until we see improvement in gout flares, tophi, blood pressure levels, and other inflammatory markers.
Test Your Gout Knowledge
In our practice, our goal is to educate our patients over the course of several months to bring their knowledge base in line with their physicians.
Test your gout knowledge using this exam.