How does salmon affect gout. What are the best ways to incorporate salmon into a gout-friendly diet. Which types of salmon are most beneficial for managing gout symptoms. How much salmon can be safely consumed by individuals with gout. What are the key nutritional benefits of salmon for gout sufferers.

Understanding Gout and Its Dietary Implications

Gout is a form of inflammatory arthritis characterized by the buildup of uric acid crystals in joints, most commonly affecting the big toe. This painful condition is often exacerbated by dietary choices, making it crucial for those diagnosed with gout to carefully consider their food intake. While chicken is often discussed in relation to gout, salmon presents an interesting alternative that deserves exploration.

Gout occurs when there’s an excess of uric acid in the body, a condition known as hyperuricemia. This excess uric acid can form crystals that accumulate in joints, leading to intense pain and inflammation. The role of diet in managing gout cannot be overstated, as certain foods can significantly impact uric acid levels.

The Purine Connection

Purines, naturally occurring substances found in many foods, are broken down by the body into uric acid. For individuals with gout, consuming high-purine foods can lead to increased uric acid levels and potentially trigger painful flare-ups. This is where careful dietary choices become crucial.

Salmon: A Nutritional Powerhouse for Gout Sufferers

Salmon stands out as a nutritional powerhouse that can be beneficial for individuals managing gout. Unlike some other animal proteins, salmon offers a range of health benefits that can support overall well-being while potentially helping to manage gout symptoms.

Omega-3 Fatty Acids: Nature’s Anti-Inflammatory

One of the most significant benefits of salmon for gout sufferers is its high content of omega-3 fatty acids. These essential fats have powerful anti-inflammatory properties that can help reduce inflammation throughout the body, including in joints affected by gout.

• EPA (Eicosapentaenoic acid) and DHA (Docosahexaenoic acid) are the primary omega-3s found in salmon
• These fatty acids can help lower inflammation markers in the body
• Regular consumption of omega-3s may reduce the frequency and severity of gout flares

How much omega-3 should gout sufferers aim for? While individual needs may vary, the American Heart Association recommends consuming at least two servings of fatty fish like salmon per week for general health benefits. For those with gout, consulting with a healthcare provider or registered dietitian can help determine the optimal intake.

Purine Content in Salmon: Navigating the Numbers

While salmon does contain purines, its content is generally considered moderate compared to other animal proteins. The purine content can vary depending on the type of salmon and how it’s prepared.

Comparative Purine Content

Here’s a comparison of purine content in different types of salmon:

1. Wild Atlantic Salmon: Approximately 170 mg of purines per 100g
2. Farmed Atlantic Salmon: About 160 mg of purines per 100g
3. Canned Pink Salmon: Around 150 mg of purines per 100g

Is salmon safe for gout sufferers to eat? In moderation, salmon can be a healthy addition to a gout-friendly diet. Its moderate purine content, combined with its anti-inflammatory properties, makes it a better choice than many other animal proteins.

Optimal Salmon Consumption for Gout Management

While salmon can be part of a gout-friendly diet, moderation remains key. Overconsumption of any purine-containing food can potentially lead to increased uric acid levels.

Recommended Serving Sizes

For individuals managing gout, a general guideline is to limit salmon intake to 4-6 ounces (113-170 grams) per serving, 2-3 times per week. This allows for the benefits of salmon’s nutrients while minimizing the risk of excessive purine intake.

How can gout sufferers incorporate salmon into their diet safely? Consider these strategies:

• Space out salmon meals throughout the week rather than consuming multiple servings in close succession
• Balance salmon consumption with low-purine foods in the same meal
• Monitor your body’s response and adjust intake accordingly

Preparation Methods: Maximizing Benefits, Minimizing Risks

The way salmon is prepared can impact its overall health benefits and potential risks for gout sufferers. Certain cooking methods can help reduce purine content while preserving beneficial nutrients.

Gout-Friendly Cooking Techniques

Which cooking methods are best for preparing salmon when managing gout?

1. Grilling: Allows excess fat to drip away, potentially reducing overall purine content
2. Baking: A gentle cooking method that preserves nutrients without adding extra fats
3. Poaching: Can help reduce the fat content of the fish
4. Steaming: Preserves nutrients and doesn’t require additional fats

Avoid deep-frying or cooking methods that add excessive fats, as these can exacerbate inflammation and potentially worsen gout symptoms.

Complementary Foods: Building a Gout-Friendly Meal Plan

Incorporating salmon into a well-rounded, gout-friendly meal plan involves careful consideration of complementary foods. The right combination can enhance the overall nutritional profile while helping to manage uric acid levels.

Low-Purine Accompaniments

Pair salmon with these low-purine foods to create balanced, gout-friendly meals:

• Leafy green vegetables (spinach, kale, arugula)
• Whole grains (quinoa, brown rice, oats)
• Legumes (lentils, chickpeas, black beans)
• Fresh fruits (cherries, berries, citrus fruits)
• Low-fat dairy products (yogurt, milk, cottage cheese)

How can these foods complement salmon in a gout-management diet? These low-purine options provide essential nutrients, fiber, and anti-inflammatory compounds that can support overall health and potentially help manage gout symptoms.

Hydration: The Unsung Hero in Gout Management

While focusing on salmon and other dietary choices, it’s crucial not to overlook the importance of proper hydration in managing gout. Adequate fluid intake plays a vital role in helping the body flush out excess uric acid.

Water: Nature’s Gout-Fighting Elixir

How much water should individuals with gout aim to drink daily? While needs vary based on factors like body size, activity level, and climate, a general guideline is to consume at least 8-10 glasses (64-80 ounces) of water per day.

Benefits of proper hydration for gout management include:

• Helps dilute uric acid in the bloodstream
• Supports kidney function in excreting excess uric acid
• May reduce the risk of uric acid crystal formation in joints
• Supports overall health and bodily functions

Consider incorporating herbal teas, particularly those with anti-inflammatory properties like green tea or chamomile, as part of your daily fluid intake.

Monitoring and Adjusting: Personalized Gout Management

While general guidelines provide a helpful starting point, managing gout effectively often requires a personalized approach. Each individual’s body may respond differently to dietary changes, including the incorporation of salmon.

Tracking Symptoms and Triggers

Keeping a food and symptom diary can be an invaluable tool in identifying personal triggers and optimizing a gout-friendly diet. This practice allows individuals to:

• Record daily food intake, including salmon consumption
• Note any gout flare-ups or changes in symptoms
• Identify potential correlations between diet and gout activity
• Make informed decisions about dietary adjustments

How often should gout sufferers reassess their dietary plan? It’s advisable to review your food diary and symptom patterns every few weeks, or more frequently if experiencing regular flare-ups. This ongoing monitoring allows for timely adjustments to optimize gout management.

Beyond Diet: Holistic Approaches to Gout Management

While diet, including the thoughtful incorporation of salmon, plays a crucial role in managing gout, it’s important to consider other lifestyle factors that can impact the condition.

Exercise: Finding the Right Balance

Regular physical activity can support weight management and overall health, both of which are beneficial for gout sufferers. However, it’s important to approach exercise cautiously to avoid triggering flare-ups.

What types of exercise are best for individuals with gout?

• Low-impact activities like swimming, cycling, or elliptical training
• Gentle yoga or tai chi for flexibility and stress reduction
• Strength training with proper form and moderate weights
• Daily walking, gradually increasing duration and intensity

Always consult with a healthcare provider before starting a new exercise regimen, especially if you have active gout symptoms.

Stress Management: A Key Component

Chronic stress can potentially exacerbate gout symptoms and trigger flare-ups. Incorporating stress-reduction techniques into your daily routine can complement dietary efforts in managing gout.

Effective stress management strategies may include:

1. Mindfulness meditation or deep breathing exercises
2. Regular engagement in hobbies or enjoyable activities
3. Adequate sleep and maintaining a consistent sleep schedule
4. Seeking support from friends, family, or support groups
5. Professional counseling or therapy when needed

The Role of Supplements in Gout Management

While a balanced diet including salmon can provide many essential nutrients, some individuals with gout may benefit from targeted supplementation. However, it’s crucial to approach supplements cautiously and under professional guidance.

Potential Beneficial Supplements

Which supplements might be helpful for individuals managing gout?

• Vitamin C: May help lower uric acid levels and reduce gout risk
• Cherry extract: Contains antioxidants that may help reduce inflammation and gout flares
• Omega-3 supplements: For those who don’t consume enough fatty fish like salmon
• Folate: May help lower uric acid levels in some individuals

It’s important to note that supplements should not replace a balanced diet or prescribed medications. Always consult with a healthcare provider before starting any new supplement regimen, as some may interact with gout medications or have contraindications for certain individuals.

Navigating Social Situations and Dining Out

Managing gout doesn’t mean completely avoiding social situations or never dining out. With some planning and mindful choices, it’s possible to enjoy meals with friends and family while adhering to a gout-friendly diet.

Tips for Dining Out

How can individuals with gout make smart choices when eating at restaurants?

1. Research menus in advance to identify gout-friendly options
2. Don’t hesitate to ask about ingredients or preparation methods
3. Choose grilled, baked, or steamed dishes over fried options
4. Opt for salmon or other fatty fish over red meats or organ meats
5. Request dressings and sauces on the side to control portions
6. Balance your plate with plenty of vegetables and whole grains
7. Stay hydrated by drinking water throughout the meal

Remember, an occasional indulgence is unlikely to trigger a severe flare-up in most individuals. The key is maintaining overall balance and moderation in your diet.

The Importance of Regular Medical Check-ups

While dietary management, including the thoughtful incorporation of salmon, plays a crucial role in gout control, regular medical check-ups remain essential. These visits allow for monitoring of uric acid levels, assessment of treatment efficacy, and timely adjustments to the management plan.

What to Expect During Gout Check-ups

Regular gout check-ups typically involve:

• Blood tests to measure uric acid levels
• Physical examination to assess joint health and function
• Review of symptoms and any recent flare-ups
• Discussion of diet and lifestyle factors
• Adjustment of medications if necessary
• Addressing any concerns or questions about gout management

How often should individuals with gout schedule check-ups? The frequency may vary depending on the severity of the condition and how well it’s controlled. Generally, every 3-6 months is recommended, but your healthcare provider can advise on the best schedule for your specific situation.

Emerging Research: Future Directions in Gout Management

The field of gout research is continually evolving, with new insights emerging about the role of diet, including foods like salmon, in managing the condition. Staying informed about these developments can help individuals make the most up-to-date choices for their gout management.

Promising Areas of Research

Some exciting areas of ongoing research in gout management include:

1. The role of the gut microbiome in uric acid metabolism
2. Genetic factors influencing gout risk and treatment response
3. Novel anti-inflammatory compounds found in foods
4. The potential of personalized nutrition based on genetic profiles
5. Advanced imaging techniques for early detection of urate crystal deposits

While these areas show promise, it’s important to remember that research takes time to translate into clinical practice. Always consult with healthcare professionals for the most current, evidence-based recommendations for gout management.

Empowering Yourself: Education and Self-Advocacy

Managing gout effectively requires more than just following a prescribed diet or medication regimen. Empowering yourself through education and self-advocacy can lead to better outcomes and improved quality of life.

Key Steps for Self-Empowerment

How can individuals with gout take an active role in their health management?

• Stay informed about gout through reputable sources and recent research
• Actively participate in treatment decisions with your healthcare team
• Join support groups or online communities to share experiences and tips
• Practice clear communication with healthcare providers about symptoms and concerns
• Set realistic goals for diet, exercise, and overall health improvements
• Celebrate small victories in managing your condition

Remember, you are the most important member of your healthcare team. Your insights, experiences, and dedication to managing your condition are invaluable in achieving the best possible outcomes.

How Much to Eat and Cooking Tips

Chicken is a lean meat with high nutritional value, but people with gout (excess uric acid in the body), also known as gouty arthritis, need to be careful about the cuts they choose, how much they eat, and how they prepare their chicken. Moderation is a key.

If you have gout, you need to consume chicken carefully. Chicken has a considerable amount of purines, chemical substances found in every cell in our body and a lot of foods. A healthy supply of purines can protect blood vessels, but an excessive amount can cause flare-ups in gout. Research has shown that excess purine intake causes high uric acid levels (hyperuricemia) and result in uric acid crystals in your joints (typically in the big toe), which can be extremely painful and even disabling.

Theresa Chiechi / Verywell

The Nutritional Value of Chicken

Unseasoned chicken is a low-sodium, sugar-and-starch-free, high-protein food choice that packs essential nutrients required for healthy metabolism, including antioxidant B vitamins (B₆ and niacin) and minerals like selenium and phosphorus. Unlike red meats, poultry, and particularly skinless, boneless chicken breast, has become a go-to animal protein for people looking to eat healthier, lose or maintain weight, and reduce their risk of disease.

Weight maintenance is one of the most important lifestyle modifications for people with gout, and the obesity epidemic has even been blamed for the high prevalence of gout. People who have gout also need to reduce the amount of purines in their diet.

Chicken: Nutrition Facts

The U.S. Department of Agriculture (USDA) provides the following nutritional information for one 3-ounce (85g) serving of grilled boneless, skinless chicken breast.

 The breakdown is as follows:

• Calories: 128
• Fat: 2.7g
• Sodium: 44mg
• Carbohydrates: 0g
• Fiber: 0g
• Sugars: 0g
• Protein: 26g

Note the 3-ounce serving size is smaller than what you’ll find conventionally packaged in stores.

The American Heart Association also recommends choosing poultry and fish without skin and preparing them in healthy ways without added saturated and trans fat. They say nutrient-dense foods like chicken may help you control your weight, cholesterol, and blood pressure.

So is chicken safe to eat when you have gout? It all depends on the cut and its purine content.

Best Cuts

The basic nutritional value differ between breasts, thighs, and wings. The purine content also varies in different parts of the chicken. For people with gout and hyperuricemia, the amount of total purines and the types of purines consumed, particularly hypoxanthine, are important considerations.

In Japan, guidelines for the management of hyperuricemia and gout recommend reduced intake of dietary purines to less than 400 mg/day.

Chicken is mostly a moderate-purine food, but the amount of purines in cuts do range from low to very high. People with gout are advised to avoid organ meats like chicken liver and only eat moderate-purine foods in sensible portions.

According to the American Dietetic Association, high-purine foods have a total purine content of 150-1000 mg/100g, and it is recommended that people who have gout or hyperuricemia avoid these foods.

per 100g

The specific purine breakdown is also good information to help you make informed choices. You want to be wary of foods high in adenine and hypoxanthine in particular since these purines in particular have been shown to have a significant association with gout. 

Breakdown of Purines in Chicken

Poultry

• Adenine 30
• Guanine 30
• Hypoxanthine 18
• Xanthine 18 

Poultry (other than organs)

• Adenine 335
• Guanine 335
• Hypoxanthine 335
• Xanthine 135

Gout-Friendly Cooking Tips

You can reduce the total purine content in your next chicken dish by following a few gout-friendly cooking guidelines. 

The first thing you can do is remove the skin as it contains additional purines and unhealthy fats. Next, researchers suggest that rinsing and cooking the chicken in water can significantly reduce total purine content of certain animal proteins like fish, making it more suitable for people with gout to consume.

Cooking in general, whether by moist heat (boiling) or dry heat (broiling), has been found to have similar effects on total purine content. It increases adenine and guanine slightly and decreases hypoxanthine compared with raw foods.  Cooking reduces purine content in chicken partly because they are released into the juices. This is why certain sauces like gravy or stew and soup bases are seen as purine-rich and why they should be avoided in people with gout. Cooking chicken by way of frying and grilling maintains the moisture level (and purine content) and stewing it means the released purines are absorbed into your stock. 

What to Avoid

You should avoid the follow if you have gout:

• Alcohol (ex. Don’t beer batter your fish)
• High-fat dairy (ex. Alfredo sauce)
• Animal fat (ex. Cooking with bacon grease)

The types of oils, marinades, sauces you use to season and cook your chicken also play an important role for people with gout. Opt for high-quality plant oils with anti-inflammatory properties like extra virgin olive oil and avocado oil. These oils can be used in cooking and marinating chicken. Season with anti-inflammatory foods and flavors from chile peppers, tomatoes, turmeric, and more.  

The purine content in chicken is also affected by storage temperatures and duration. A lower storage temperature and storage duration have been found to reduce enzyme activity and overall purine content in shrimp, suggesting similar results may be the case for chicken.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. Wu Beiwen, Rosalind Janet M, Haytowitz David B, Pehrsson Pamela R, Ershowc Abby G. Availability and quality of published data on the purine content of foods, alcoholic beverages, and dietary supplements. Journal of Food Composition and Analysis. 2019;84:103281. doi: 10.1016/j.jfca.2019.103281.x

2. Kaneko Kiyoko, Aoyagi Yasuo, Fukuuchi Tomoko, Inazawa Katsunori. Total Purine and Purine Base Content of Common Foodstuffs for Facilitating Nutritional Therapy for Gout and Hyperuricemia. Biological and Pharmaceutical Bulletin. 2014;37(5):709-721. doi: 10.1248/bpb.b13-00967.x

3. FoodData Central. U.S. Department of Agriculture. Chicken, broiler or fryers, breast, skinless, boneless, meat only, raw. Published April 2018. Updated March 1 2019.

4. The American Heart Association. Meat, Poultry, and Fish: Picking Healthy Proteins. Updated March 26 2017.

5. Ellington Anna. Reduction of Purine Content in Commonly Consumed Meat Products Through Rinsing and Cooking. University of Georgia, Athens, GA. 2005.

6. Harvard Health Publishing at Harvard Medical School. Foods that Fight Inflammation. Published June 2014. Updated August 29 2020.

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Gout diet: What’s allowed, what’s not

Gout diet: What’s allowed, what’s not

Starting a gout diet? Understand which foods are OK and which to avoid.

By Mayo Clinic Staff

Gout is a painful form of arthritis that occurs when high levels of uric acid in the blood cause crystals to form and accumulate in and around a joint.

Uric acid is produced when the body breaks down a chemical called purine. Purine occurs naturally in your body, but it’s also found in certain foods. Uric acid is eliminated from the body in urine.

A gout diet may help decrease uric acid levels in the blood. A gout diet isn’t a cure. But it may lower the risk of recurring gout attacks and slow the progression of joint damage.

People with gout who follow a gout diet generally still need medication to manage pain and to lower levels of uric acid.

Gout diet goals

A gout diet is designed to help you:

• Achieve a healthy weight and good eating habits
• Avoid some, but not all, foods with purines
• Include some foods that can control uric acid levels

A good rule of thumb is to eat moderate portions of healthy foods.

Diet details

The general principles of a gout diet follow typical healthy-diet recommendations:

• Weight loss. Being overweight increases the risk of developing gout, and losing weight lowers the risk of gout. Research suggests that reducing the number of calories and losing weight — even without a purine-restricted diet — lower uric acid levels and reduce the number of gout attacks. Losing weight also lessens the overall stress on joints.
• Complex carbs. Eat more fruits, vegetables and whole grains, which provide complex carbohydrates. Avoid foods and beverages with high-fructose corn syrup, and limit consumption of naturally sweet fruit juices.
• Water. Stay well-hydrated by drinking water.
• Fats. Cut back on saturated fats from red meat, fatty poultry and high-fat dairy products.
• Proteins. Focus on lean meat and poultry, low-fat dairy and lentils as sources of protein.

Recommendations for specific foods or supplements include:

• Organ and glandular meats. Avoid meats such as liver, kidney and sweetbreads, which have high purine levels and contribute to high blood levels of uric acid.
• Red meat. Limit serving sizes of beef, lamb and pork.
• Seafood. Some types of seafood — such as anchovies, shellfish, sardines and tuna — are higher in purines than are other types. But the overall health benefits of eating fish may outweigh the risks for people with gout. Moderate portions of fish can be part of a gout diet.
• High-purine vegetables. Studies have shown that vegetables high in purines, such as asparagus and spinach, don’t increase the risk of gout or recurring gout attacks.
• Alcohol. Beer and distilled liquors are associated with an increased risk of gout and recurring attacks. Moderate consumption of wine doesn’t appear to increase the risk of gout attacks. Avoid alcohol during gout attacks, and limit alcohol, especially beer, between attacks.
• Sugary foods and beverages. Limit or avoid sugar-sweetened foods such as sweetened cereals, bakery goods and candies. Limit consumption of naturally sweet fruit juices.
• Vitamin C. Vitamin C may help lower uric acid levels. Talk to your doctor about whether a 500-milligram vitamin C supplement fits into your diet and medication plan.
• Coffee. Some research suggests that drinking coffee in moderation, especially regular caffeinated coffee, may be associated with a reduced risk of gout. Drinking coffee may not be appropriate if you have other medical conditions. Talk to your doctor about how much coffee is right for you.
• Cherries. There is some evidence that eating cherries is associated with a reduced risk of gout attacks.

Sample menu

Here’s what you might eat during a typical day on a gout diet.

Breakfast

• Whole-grain, unsweetened cereal with skim or low-fat milk
• 1 cup fresh strawberries
• Coffee
• Water

Lunch

• Roasted chicken breast slices (2 ounces) on a whole-grain roll with mustard
• Mixed green salad with vegetables, 1 tablespoon nuts, and balsamic vinegar and olive oil dressing
• Skim or low-fat milk or water

Afternoon snack

• 1 cup fresh cherries
• Water

Dinner

• Roasted salmon (3 to 4 ounces)
• Roasted or steamed green beans
• 1/2 to 1 cup whole-grain pasta with olive oil and lemon pepper
• Water
• Low-fat yogurt
• 1 cup fresh melon
• Caffeine-free beverage, such as herbal tea

Results

Following a gout diet can help limit uric acid production and increase its elimination. A gout diet isn’t likely to lower the uric acid concentration in your blood enough to treat your gout without medication. But it may help decrease the number of attacks and limit their severity.

Following a gout diet, along with limiting calories and getting regular exercise, can also improve your overall health by helping you achieve and maintain a healthy weight.

July 02, 2020

Show references

1. Firestein GS, et al., eds. Etiology and pathogenesis of hyperuricemia and gout. In: Kelley and Firestein’s Textbook of Rheumatology. 10th ed. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Accessed May 1, 2018.
2. Becker MA. Lifestyle modification and other strategies to reduce the risk of gout flares and progression of gout. https://www.uptodate.com/contents/search. Accessed May 1, 2018.
3. AskMayoExpert. Gout. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2018.
4. Beyl RN, et al. Update on importance of diet in gout. The American Journal of Medicine. 2016;129:1153.
5. Zeratsky KA (expert opinion). Mayo Clinic, Rochester, Minn. May 9, 2018.

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Should Gout Patients Eat Salmon?

Relief from your gout in as little as 2 hours and no more recurring attacks that experts have linked to potentially fatal health conditions. Click or tap for more… 

Do you love salmon but have gout and are wondering whether or not to keep it in your diet? In this article you’re going to discover exactly that; the pros and cons of having salmon in your gout diet.

Salmon and Gout

Salmon is mostly found in the Atlantic and Pacific oceans as well as inland lakes in North America and Northern Europe. The most commercially fished types are Atlantic, King (Chinook), Chum (Keta), Coho (Silver), Pink (Humpback), and Sockeye (Red).

Salmon (along with tuna) is in the top 3 most frequently consumed seafoods lists in the U.S., U.K., and Australia. So it’s extremely popular. And no wonder, apart from it’s beautiful flavor, it’s jam-packed full of healthy nutrients making it one of the healthiest foods on the planet…

Health Benefits of Salmon

All types of salmon are rich in:

• omega-3 fatty acid (essential fatty acid)
• protein
• B vitamins (1, 2, 3, 5, 6, 9 and 12)
• vitamin D
• selenium

It’s also a good source of:

• potassium
• astaxanthin (antioxidant)
• iodine
• choline

The outcome is that several studies suggest that a regular diet of wild salmon can help to lower the risk of:

• some cancers (e.g. leukemia, colorectal, prostate, breast).
• heart disease and heart attack.
• stroke.
• high blood pressure.
• heart arrhythmia.
• macular degeneration.

And help to:

• improve brain function.
• protect joint cartilage.
• stabilize blood sugar.
• lower stress and anxiety.
• improve bone health.
• improve the immune system.
• improve eye health.
• reduce inflammation
• help protect the body’s cells.

You can see that salmon is packed full of vitamins, minerals, and other nutrients that make it one of the healthiest foods out there.

So why wouldn’t you want to eat it regularly as part of a healthy diet?

Well, if you suffer from gout, you have to balance the undoubted health benefits against any risk that salmon could trigger excruciating gout.

So let’s consider that then…

Salmon: Good or Bad for Gout?

The first thing to consider, of course, is salmon’s purine content. Remember, gout is caused by higher than normal levels of serum uric acid out of which crystals of urate accumulate in the joints and surrounding tissue.

But uric acid is a byproduct of the chemical breakdown of purines that exist in our body’s cells and the cells of foods we consume. The higher the purine content of food, the more uric acid is produced. So we need to avoid foods that have the highest purine concentrations.

So how does salmon rate in the purine / uric acid table?

Purine Content of Salmon

Smoked salmon is rated as a “high” purine food: it contains >200 mg uric acid per 3.5 oz (100 g) food serving. So smoked salmon should be excluded from your gout diet.

But although foods with a high purine content should be avoided, foods with a moderate purine content may be consumed..well…in moderation!

Which is great news for us gout sufferers because cooked and canned salmon are rated as being “moderately high” in purines, i.e. containing 100-200 mg uric acid per 3.5 oz (100 g) serving.

So grilled or baked salmon, for example, may be eaten in moderation, which means limiting your intake to 1 x 3. 5 oz (100 g) serving per day.

But there’s more to consider…

Salmon’s Gout-Friendly Nutrients

Another consideration is the ability of certain vitamins, minerals and other nutrients to actually help in the fight against gout. For example…

Omega-3 fatty acids help to reduce inflammation in the joints.

Vitamin B9 (folic acid) can inhibit the xanthine oxidase needed to produce uric acid, and vitamin B5 (pantothenic acid) is an important element in the uric acid excretion process.

Potassium is important for gout sufferers because studies have shown that a potassium deficiency can actually raise uric acid levels in the blood.

Potassium is also alkaline forming, meaning that it can help to move the body towards a more alkaline state which, in turn, can help to prevent urate crystal formation and urate kidney stones.

Selenium helps to regulate excessive immune response and chronic inflammation, which is what occurs when urate crystals form in the joints during a gout flare.

So you can see that some of the nutrients in salmon have the potential to be somewhat beneficial to gout sufferers.

Salmon and Gout: The Verdict

The key is to strike a balance between salmon’s health benefits on the one hand, and its purine content on the other.

On balance, then, as long as you completely avoid smoked salmon and only consume cooked or canned salmon in moderation you’ll get the overall health benefits without raising the risk of a gout flare.

But remember that salmon is only one part of your gout diet…

What you don’t want to be doing is eating one moderate portion of salmon and then thinking you can get away with consuming other moderate to high purine foods on the same day. You can’t. Your total daily purine intake will determine your risk of having a gout flare.

My brand new breakthrough guide “Gout Rescue” gets you relief from your gout in as little as 2 hours and prevents the recurring attacks experts have linked to some potentially fatal health conditions. Click or tap here for the facts. 

So, on the days you have salmon, ensure your other meals contain low-purine foods such as potatoes, tomatoes, other vegetables (especially leafy greens), herbs, pasta, rice, whole grain cereals, peanut butter, eggs, cheese, milk, natural yogurt, and fruit.

[Note: My guide “Gout Rescue” has detailed information on high, moderate, and low purine foods and ingredients, along with tons of daily meal ideas for gout sufferers.]

I’ve had recurring gout most of my adult life but haven’t had a gout attack for 11+ years now. Whether this is your first gout attack, or you’ve had multiple flare-ups, the content on here will, hopefully, set you on the road to being gout-free too.

Gout Diet With Fish | Livestrong.com

Gout Diet With Fish

Image Credit: xamtiw/iStock/GettyImages

Gout sufferers need to avoid foods high in purines — naturally occurring compounds that your body metabolizes into uric acid. When your blood has too high a concentration of uric acid, it can accumulate in your joints, causing the swelling, inflammation and pain characteristic of gout.

While fish should be a part of a gout diet since they provide the omega-3 fatty acids that can help prevent heart disease and high blood cholesterol, certain types of fish may exacerbate gout symptoms. If you have questions about which seafoods are safe for a gout diet, talk to your doctor.

Fish to Avoid

Foods that contain 150 to 825 milligrams of purine compounds in every 100 grams are considered to be high-purine items and should be avoided by individuals on a gout diet. A number of fish fall into this category, including anchovies, mackerel, herring, sardines, cod, haddock and trout. Canned versions of these foods are also not allowed on a gout diet. Canned sardines have 480 milligrams of purines per 100 grams, and canned herring has 378 milligrams.

Fish to Include

Fish that don’t fall into the high-purine category contain a moderate amount of purine compounds, with 50 to 150 milligrams of purines in every 100 grams. Examples include salmon, canned light tuna, flounder, sole and catfish.

People following a gout diet can include these fish in their diet, but only in moderation. One to two total servings of high-protein foods like moderate-protein fish, shellfish, poultry, lean meat, beans and legumes per day is recommended for gout patients, with a single serving of fish being equivalent to 2 to 3 cooked ounces.

Preparation Tips

It’s important for a person adhering to a gout diet to keep his intake of high-fat foods as low as possible. Excess fat can stimulate your kidneys to retain uric acid, possibly leading to a flare-up of gout symptoms.

Instead of breading and deep-frying fish, try grilling, roasting or poaching fresh fillets with a minimum of added monounsaturated or polyunsaturated fats like olive or canola oil. To keep your sodium intake low, season fish with herbs, spices or fresh-squeezed lime or lemon juice instead of salt or high-sodium seasoning mixes.

Expert Insight

The Natural Resources Defense Council recommends choosing low-mercury fish when you eat seafood, especially if you are a pregnant or nursing woman or one who is trying to become pregnant. Avoid ahi tuna, swordfish, orange roughy and marlin, all of which are likely to have high levels of mercury contamination.

Fish like canned albacore tuna, bluefish, snapper and halibut can be eaten occasionally — between three to six times per month — but low-mercury, moderate-purine varieties such as flounder, tilapia, salmon and whitefish are the best choices.

Gout: What to Eat and Avoid

Gout used to be known as a ‘rich man’s disease’ back in the day because it stemmed from having a diet full of food that only the rich could afford. With different types of food made more accessible to all these days, gout can affect more people than you think.

Gout is a type of arthritis that causes sudden pain, swelling and inflammation of the joints with almost half of all cases affecting the big toes. Other places it affects include the fingers, wrists, knees and heels.

In healthy bodies, uric acid (a by-product that comes from the digestion of certain types of food) is easily removed from the body when it passes though the kidneys into urine. However, when the kidneys cannot process uric acid efficiently or if there is too much uric acid in the blood, urate crystals accumulate in the joints which triggers pain, swelling, and inflammation. A gout attack happens when uric levels in the blood are high and the body is unable to break down the acids efficiently. These attacks commonly happen at night and can last between 3 – 10 days.

Food to avoid if you have gout

Food high in purines (containing more than 150 – 200mg of purines per 100 grams) may raise your uric acid levels. These include:

• Organ meats – liver, kidney, and brain
• Red meat and game meat such as veal and venison
• Seafood – scallops, crab, shrimp and roe
• Fish – herring, trout, mackerel, tuna, sardines, anchovies
• Alcohol and beer
• Sugary drinks – fruit juice and carbonated drinks
• Added sugar – honey, agave nectar and high-fructose corn syrup
• Yeasts – nutritional yeast, brewer’s yeast and other yeast supplements

Besides the meats and fish mentioned above, meats such as chicken, beef, pork and lamb should be eaten in moderation as they contain a moderate amount of purines (between 100 – 200mg per 100 grams). Consuming too much of these meats may trigger a gout attack. However, salmon can be eaten in moderation as it contains lower levels of purines compared to other fish.

Food that’s suitable for gout

Low purine food (containing less than 100mg of purines per 100 grams) that are generally safe for those who have gout include:

• Fruits – cherries may help to prevent attacks by lowering uric acid levels and could reduce inflammation.
• Vegetables – high purine vegetables such as asparagus and spinach don’t increase the risk of gout or gout attacks
• Legumes
• Nuts
• Whole grains
• Dairy products, especially low-fat dairy
• Eggs
• Coffee, tea and green tea
• Herbs and spices
• Plant-based oils – canola, coconut, olive and flax

Gout-friendly festive feasting

Eating, drinking and being merry during the many festive seasons of Singapore is inevitable. For those with gout, it may be a little harrowing, dodging food and drinks that will trigger an attack. Here are a few tips to keep in mind so you can stay happy and healthy.

• Remember that festive food and drinks are often high in purines, made with lots of seafood, red meat, wine and more. To help avoid an attack, drink plenty of water and fluids to flush out the uric acid in your blood. Do let your host know you have gout so they won’t press you to indulge in food and drink that could cause an attack.
• Stick to chicken, turkey and salmon which contain a moderate amount of purines, and fill up more on vegetables and fruits!
• Alcohol is a source of purines and also affects the rate that uric acid is removed from your body, which can lead to increased uric acid levels in your blood. Spirits have the lowest purine content whereas beer has the highest. Bear in mind that alcoholic drinks will cause your uric acid levels to increase. If you must, stick to just one glass of your preferred alcoholic beverage and try to avoid beer.
• Keep everything in moderation! A day of feasting and merriment may be ‘worth it’ in the moment, but is it worth the following week of discomfort?

Sample of a gout-friendly menu:

Breakfast

• Whole-grain, unsweetened cereal with skim or low-fat milk
• 1 cup fresh strawberries
• Coffee
• Water

Lunch

• Roasted chicken breast (60g)
• 1 cup of cooked brown rice
• Stir-fry vegetables
• Caffeine-free beverage

Afternoon snack

• 1 cup fresh cherries
• Water

Dinner

• Roasted salmon (90g)
• Roasted or steamed vegetables
• 1/2 to 1 cup pasta with olive oil and lemon pepper
• Low-fat yoghurt
• A small handful of almonds or walnuts

What else can you do?

If you are overweight, your doctor/dietitian might advise you to lose some weight because being overweight may lead to insulin resistance, which promotes high uric acid levels. Increasing your frequency of exercise not only helps you lose weight but can also help to keep your uric acid levels low. Making sure that you’re properly hydrated is also important because urinating can help remove excess uric acid from the blood. Take note to drink more water if you’re exercising in order to make up any water loss from sweating. Lastly, limit your intake of alcohol as it’s a common trigger for gout attacks.

Following a gout-friendly diet detailed by a dietitian can help alleviate its symptoms and although it is not a cure, it can slow down the progression of joint damage. There are also medications that can be taken to lower uric acid levels. Speak to an orthopaedic specialist to understand how you can manage your condition.

Article reviewed by
Dr Kevin Koo, orthopaedic surgeon at Mount Elizabeth Hospitals
Grace Yanni Yanti, senior dietitian at Mount Elizabeth Hospitals

References

Best Diet for Gout: What to Eat, What to Avoid. Retrieved on 22 November 2020 from https://www.healthline.com/nutrition/best-diet-for-gout#TOC_TITLE_HDR_4

What You Need to Know About Alcohol and Gout. Retrieved on 22 November 2020 from https://www.healthline.com/health/gout-and-wine#gout-alcohol

Foods to Avoid and Low-Purine Foods to Eat Instead

Gout is a painful form of arthritis that happens when too much uric acid builds up and forms crystals in your joints. Your body makes uric acid after it breaks down a substance called purine, which is found in many foods.

One of the things that may help you manage your gout is to reduce the amount of purines you eat. Keep in mind that while what you eat can affect how much uric acid your body produces, the effects are small compared to medication.

No specific eating plan will completely prevent flare-ups, but a good gout diet will help you:

• Reach a healthy weight
• Set and stick to good eating habits
• Limit foods with purines
• Add foods that can help control uric acid levels

Foods to Avoid if You Have Gout

Skip foods and drinks that are high in purines to help lower your chances of an attack.

You should stay away from these types of food:

• Beer and grain liquors (like vodka and whiskey)
• Red meat, lamb, and pork
• Organ meats, such as liver, kidneys, and glandular meats like the thymus or pancreas (you may hear them called sweetbreads)
• Seafood, especially shellfish like shrimp, lobster, mussels, anchovies, and sardines
• High-fructose products like soda and some juices, cereal, ice cream, candy, and fast food

Best Foods for a Gout Diet

You’ll want to go for low-purine options like:

• Low-fat and nondairy fat products, such as yogurt and skim milk
• Fresh fruits and vegetables
• Nuts, peanut butter, and grains
• Fat and oil
• Potatoes, rice, bread, and pasta
• Eggs (in moderation)
• Meats like fish, chicken, and red meat are fine in moderation (around 4 to 6 ounces per day).
• Vegetables: You may see veggies like spinach and asparagus on the high-purine list, but studies show they don’t raise your risk of gout or gout attacks.

What Can You Drink if You Have Gout?

Foods aren’t the only thing that can affect uric acid. What you drink matters, too.

Dos

It’s a good idea to drink lots of fluids — 8 to 16 cups a day. At least half of what you drink should be water. Vitamin C (think orange juice) also can help lower uric acid, but studies also show that the high fructose in OJ may boost uric acid levels, so drink it in moderation. Caffeinated coffee can cut uric acid, too, as long as you don’t overdo it.

Don’ts

Stay away from sugary drinks like soda and fruit juice. You also may need to limit or avoid alcohol as well. Talk with your doctor to find out what’s right for you.

While a healthy diet can help control how much uric acid is in your system, you may still need medicine to prevent future attacks. Talk with your doctor about all your treatment options.

Purine Content in Fish and Seafoods

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Purine content in fish varies depending on the type and processing. Japanese researchers measured purine content in fish and seafood common in their diet. Depending on the purine level in 100g of edible portion of the food, and risk of gout, they classified them into six classes.

1. Very low purine sources, <50mg: In this class are roes (eggs) of salmon and herring.
2. Low purine sources, 50 – 100mg: Fish with this low purine level include Japanese eel, monkfish, red king crab, botan shrimp, squid organs and caviar.
3. Moderate purine sources, 100 – 200mg: Common fish and seafood in this category include salmon, tuna, bastard halibut, mackerel, rainbouw trout, seabass, spiny lobster, herring, kuruma shrimp, octupus, oyster.
4. High purine sources, 200 – 300mg: Of the common fish with high purine content is sardine. Other examples are oriental shrimp, krill, half-dried mackerel.
5. Very high purine sources, >300mg: This level of purine in the fish and seafood is mostly as a result of drying, which increases the concentration of purines. This class of products need to be avoided or their consumption reduced. Examples are dried sardine, anchovies, and sakura shrimp.

 An extended list of fish and seafood, including organs, with their purine content is presented below. The uric acid content is what the corresponding purine amount in the food would convert to in the body.

Purine in Fresh and Processed Fish

Table 1: Total purines and uric acid content in fresh and processed fish.

Fish type	Total Purines (mg/100g)	Total Uric acid (mg/100g)	Category
Fresh fish
Bastard halibut	133.4	163.1	moderate
Bonito	211.4	258.9	high
Carp	103.2	126. 1	moderate
Chub mackerel	122.1	149.6	moderate
Fat greenling	129.1	158.0	moderate
Flying fish	154.6	188.3	moderate
Gnome fish, meat	150.8	184.4	moderate
Gnome fish, skin	382.3	435.5	very high
Herring	139.6	169.8	moderate
Jack mackerel	165.3	198.4	moderate
Japanese amberjack	120.8	147.9	moderate
Japanese eel	92.1	110.9	low
Japanese seabass	119.5	146.2	moderate
Mebaru	124. 2	151.3	moderate
Monkfish, meat	70.0	84.2	low
Monkfish, liver, raw	104.3	121.8	moderate
Monkfish, liver, steamed	399.2	468.2	very high
Pacific saury	154.9	184.9	moderate
Raibow trout	180.9	216.8	moderate
Red seabream	128.9	158.0	moderate
Sablefish, meat	123.3	151.1	moderate
Sablefish, skin	66.9	80.8	low
Sailfin sandfish	98.5	117.7	low
Salmon	119.3	146.2	moderate
Sardine	210.4	247.1	high
Silllaginidae	143.9	176.5	moderate
Spanish mackerel	139.3	171.5	moderate
Striped pigfish	149.3	183.2	moderate
Tilefish	119.4	146.2	moderate
Tuna	157.4	193.3	moderate
Dried fish, canned fish, processed fish
Jack mackerel, half-dried	245.8	289.1	high
Pacific saury, half-dried	208.8	245.4	high
Sardine, half-dried	305.7	358.1	very high
Anchovy, dried	1108.6	1314.2	very high
Bonito, dried (katsuaobushi)	493.3	600.1	very high
Baby sardines, dried	746.1	879.2	very high
Whitebait, dried	471.5	554.0	very high
Salmon, canned	132.9	159.7	moderate
Tuna, canned	116.9	142.9	moderate
Fish ball	67.6	80.7	low
Fish sausage	22.6	26.9	very low

Next page has total purines and uric acid content in fish roe, fish milt, and seafoods.

Gout_part 1_Disease of Kings or Queen of Diseases? – “Mother and Child

“Gout” in translation from Greek means “a trap on the foot.” Gout has been mentioned since the time of Hippocrates (2.5 thousand years ago, in the 5th century BC), when he first described syndrome of acute pain in the area of ​​the big toe on the foot , which he actually called “gout “. By the end of the 20th century, gout began to be considered as a disease of the accumulation of uric acid salts in the structure of the joints, subcutaneous tissue, bones and kidneys

“Gout” in translation from Greek means “a trap on the foot.”Gout has been mentioned since the time of Hippocrates (2.5 thousand years ago, in the 5th century BC), when he first described syndrome of acute pain in the area of ​​the big toe on the foot , which he actually called “gout “. By the end of the 20th century, gout began to be considered as a disease of the accumulation of uric acid salts in the structure of the joints, subcutaneous tissue, bones and kidneys .

Disease of kings, geniuses?

For a long time, gout has been called “the disease of kings or the queen of diseases”, “the lord’s ailment” and was even considered a sign of genius.Many famous people who left their mark on world history suffered from gout. These were people of genius: Isaac Newton, Albert Einstein, Charles Darwin, Peter I, Leo Tolstoy, Michelangelo, Leonardo da Vinci, Alexander the Great. In the poem by N.A. Nekrasov “Who lives well in Russia?” on behalf of the author, the following lines are heard: “Leave me, Lord, my honorable illness. According to her, I am a nobleman. ”

Relatively recently, it became known that uric acid is similar in structure to caffeine and has a caffeine-like effect, that is, it stimulates mental activity.People with outstanding mental ability have elevated levels of uric acid, even if they do not have gout. There are many assumptions on this score, but the exact mechanism of this phenomenon cannot yet be explained by world science. Thus, all patients diagnosed with gout have a chance to become somewhat brilliant. The only trouble is that with gout, the joints are damaged with severe pain and dysfunction, damage to the kidneys and other organs.

Currently, gout is one of the most common joint diseases in people over 40, more often in men. Men get gout 9-10 times more often than women. The peak incidence is observed in men aged 40-50 years, and in women over the age of 60 years. This is due to the fact that the female sex hormones estrogens have a beneficial effect on the metabolism of purines and have a good uricosuric effect (well excreted uric acid in the urine).

The clinical picture of gout and why the “disease of kings” is dangerous.

The appearance of a gout patient is very characteristic, which is reflected in many illustrations.This is, as a rule, a middle-aged man, good-natured, overweight (overweight or obese), suffering, in addition, arterial hypertension (increased blood pressure), abusing alcohol and meat food.

Gout develops either with excessive formation of uric acid in the body, or with insufficient excretion of uric acid by the kidneys, or by a combined mechanism. In 90% of cases, gout begins with arthritis of the first toe.The clinical picture of gout is very characteristic. The attack usually begins at night or early in the morning and is accompanied by severe pain in the specified joint, swelling and redness. The pain syndrome is constant throughout the day, the pain does not stop at rest, intensifies at night, with the slightest movement, light touch (the so-called “bed sheet” pain). The patient is unable to move due to pain. At the same time, the body temperature often rises even to sufficiently high numbers. The first attack can last from several hours to several days.At the onset of the disease, acute arthritis can be stopped on its own, with repeated attacks, as a rule, treatment is required.

The disease proceeds in waves, that is, periods of exacerbation alternate with “light” intervals. A gout attack can be triggered by physical exertion, trauma, stress, a violation of diet (alcohol, meat, fish and other foods that increase the level of uric acid in the blood), fasting, overheating or hypothermia.

With repeated attacks of gouty arthritis, that is, with chronic gout, other joints (knee, ankle, joints of the hands and feet, elbow, much less often – shoulder, hip, temporomandibular) may be affected, tofuses (accumulations of monosodium uric acid salt) appear … Topuses are localized in soft tissues in the area of ​​the affected joints, ears and bones, which leads to destruction (destruction) of the joints. Also, tophuses can be localized on the eyelids, tongue, larynx, in the heart (causing conduction disturbances and dysfunction of the valve apparatus), in the kidneys.In some cases, subcutaneous tophuses can reach large sizes, ulcerate with the separation of a tiny white mass, and there may be cases of local inflammation (including purulent).

In all patients with gout, periodically or constantly in the blood, an increased level of uric acid (hyperuricemia) is determined, which is a mandatory criterion for the diagnosis of this disease. During the period of acute arthritis, the normal level of uric acid is often determined in the blood.An assessment of this indicator in dynamics is required during a re-examination.

A poor prognostic sign is kidney damage with gout. It could be nephrolithiasis (presence of kidney stones). The basis of stones in most cases is made up of uric acid salts (sodium monourate). Only in 10–20% of patients, calcium oxalates or calcium phosphate are found in the stones. Also, with gout, urate nephropathy can develop, which is characterized by the deposition of sodium monourate in the kidney tissue.This variant of kidney damage is associated with a high risk of developing severe renal failure.

Asymptomatic hyperuricemia and risk groups for gout.

Often we have to deal with hyperuricemia in people who have never suffered attacks of acute arthritis. This is asymptomatic hyperuricemia, a clinical syndrome distinct from gout, which in most cases is part of the metabolic syndrome manifested by obesity, type 2 diabetes (or increased fasting blood glucose), increased blood cholesterol levels, vascular atherosclerosis, coronary heart disease, and hypertension.All of these conditions can increase the risk of developing gout, which often occurs after long-term asymptomatic hyperuricemia.

The development of gouty arthritis is often associated with excessive consumption of protein foods (meat, fish, offal, legumes, etc.), alcohol, taking certain medications (diuretics, aspirin and its derivatives, cyclosporine), lead intoxication. Also important is a hereditary predisposition to impaired purine metabolism (in this case, gout can occur at a young age, there are cases of the disease in relatives).Gouty arthritis can provoke trauma, exercise. Of great importance for the development of hyperuricemia and gout are kidney diseases accompanied by chronic renal failure.

Treatment of gout is directed, , firstly, at stopping a gouty attack. Further, in the interictal period, when all symptoms of arthritis are absent, treatment is needed to normalize the level of uric acid in the blood (diet, medications, medical supervision), which prevents the progression of the disease and reduces the risk of complications.Chronic tofus gout, nephropathy is the result of insufficient treatment of gout, both during acute episodes and especially in the interictal period.

It should be noted that such patients should be treated and monitored by a rheumatologist who uses an integrated approach to treatment, not limited only to symptomatic measures during an attack.

90,000 Gouty arthritis: description of the disease, causes, symptoms, cost of treatment in Moscow

A type of inflammatory process in the joints is the presence of gouty arthritis.With this disease, uric acid accumulates in the articular structure. Under its influence, the destruction of hyaline cartilage and periarticular tissues occurs. There is a certain order when pathological changes are sequential. First, the exchange of uric acid is disturbed, its amount in the blood increases. Then crystals of this acid are deposited on the hyaline cartilage of the joint. After that, the articular structure is irritated and damaged, an inflammatory process develops, that is, arthritis.Further, the consequences of such inflammation develop, the periarticular tissue grows.

With gouty arthritis, the kidneys are affected, nephritis and urolithiasis develop. This is explained by the deposition of urate stones in the pelvis and ureters. Basically, with this disease, small joints (toes) are affected. In more rare cases, the ankle and knee joints, fingers, wrist and elbow joints are affected.

In most cases, the disease occurs in men, whose age ranges from 30 to 55 years.However, gouty arthritis can appear before the age of 30. The inflammatory process lasts for a long time, there are constant relapses. The appearance of true gout is observed in the elderly, who confuse the disease with arthrosis.

Medical practice knows cases when both small and large joints of the arms and legs are affected by a certain form of gouty arthritis. If the disease progresses slowly, only small joints are affected.The disease in rare cases provokes the presence of severe systemic reactions, although they are known in medical practice. It should be noted that with a prolonged course of gouty arthritis, the function of the affected joints is impaired, as a result of which the patient may become disabled.

There are some periods of the development of the disease. During the latency period, there are no clinical symptoms, therefore, the presence of the disease can be determined based on the increased level of uric acid. During an acute relapsing period, the joints are severely affected, the appearance of severe gouty attacks is noted.The chronic period of gouty arthritis is characterized by long periods of remission. Attacks can appear from once every 10-20 days or in several months.

Gouty arthritis differs in a rather typical clinical picture, therefore, it is possible to determine the disease in a person in a timely manner. The first manifestations are painful sensations in the joint of the big toe, reddened skin over the inflamed joint. In addition, the person responds that the pain increases during movement, the body temperature rises to 39 degrees.

Some of the manifestations of gouty arthritis need to be considered in more detail. The thumb is primarily affected. In the absence of adequate diagnostic and treatment measures, the disease will necessarily begin to progress. As a result, the small joints will be affected by the inflammatory process.

The high activity of gouty arthritis contributes to the reddening of the skin over the affected joint. The general temperature response is a complement.If the inflammatory process continues for a long time, tofuses will begin to form. These are subcutaneous nodules around the joint. Tofus consists of elements of articular tissue and uric acid. There is a gradual destruction of the articular cartilage, and cavities are formed in the bone adjacent to the joint. Such cavities are filled with sodium monourate crystals. In addition, uric acid is deposited in the tissue that surrounds the affected joint and under the skin above it. Such deposits are dense whitish nodules.As a result of the appearance of such nodular deposits and bone growths, the appearance of the leg changes greatly. If during this period a person does not seek qualified treatment, he may become completely disabled and lose the opportunity to self-service.

Why does the disease appear

If we talk about the etiology of the disease, it has not been fully studied. However, there are major risk factors. These include:

• The presence of a hereditary predisposition.

• A person does not adhere to proper nutrition, excessively abuses meat, sausage, coffee, alcohol.

• Concomitant diseases are present. Such diseases include heart failure, hemoblastosis, kidney disease, hormonal abnormalities.

• If a person uses certain medications that lower blood pressure.Also, such medicines include diuretics, cytostatics, etc.

Gouty arthritis can be primary or secondary. The development of primary gout occurs due to the fact that a genetic predisposition and a high intake of purines are combined with those foods that were listed earlier. The development of secondary gout is associated with the presence of the above diseases and taking medications.

Microcrystals of sodium urate accumulate in the joints slowly, symptoms are absent for a long time.The disease manifests itself after provoking a certain factor (physical fatigue, injury, penetration of infection, stressful condition, after hypothermia, starvation, the use of harmful products along with alcoholic beverages).

How to Diagnose Gouty Arthritis

The key point in diagnostic procedures is to detect sodium urate crystals in the synovial fluid of the joint. This must be done when an attack or remission begins.Analyze the synovial fluid located in any large joint. The fence is taken even from a joint that has never been exposed to an inflammatory process. It could be a knee joint. In addition, the contents of tofus (or any other biological material) can be taken, which is then sent for research.

It should be noted that with an increased content of uric acid and periodic inflammation of the joints located on the big toe, the diagnosis of gouty arthritis is not made.These indicators only indicate that a person has impaired purine metabolism. There are a large number of cases when a person has an increased level of uric acid in the blood, but there is no gout.

If the disease continues for a long period of time, the patient is recommended to undergo an X-ray examination. The early stage of gouty arthritis is characterized by the absence of any characteristic changes. After that, certain symptoms will appear on the X-ray, which indicate the presence of gouty arthritis.These symptoms include cartilaginous destruction, a defect in the end portion of the bone, the presence of punctures. If gouty arthritis develops on the upper limb, it is difficult to distinguish it from another joint disorder. Namely: from rheumatoid arthritis, osteoarthritis, etc.

Diet food for gout

Given that gouty arthritis is a consequence of not following the correct diet, a complete cure for the disease will not occur if the necessary dietary recommendations are not strictly followed.Therefore, gout is often progressive. A person with such a diagnosis should conscientiously treat such a therapeutic measure as a diet.

The most important principle is to avoid foods that contain high amounts of purine. The breakdown of such substances provokes the appearance of a powerful release of uric acid. At the same time, she does not have time to be excreted from the body. The patient is allowed to eat wheat and rye bread, borscht, okroshka, milk noodles, boiled beef, chicken, turkey, lean fish, eggs, cottage cheese, milk.And also, potatoes, beets, carrots, tomatoes, cucumbers, pumpkins, cabbage, berries, jam, nuts, not strong tea, vegetable and fruit juices, vegetable and butter.

Not recommended for consumption meat, fish, mushroom rich broth, pork, lamb, sausage, fatty fish, canned food, pickles, spicy food. In addition, dietary food should exclude the use of porcini mushrooms, champignons, pastries, herbs, raspberries, chocolate, strong coffee, alcohol, pepper, mustard, feta cheese, seafood.

A patient with gouty arthritis needs to remember that an excess of certain foods is not allowed. If a situation arises when prohibited food has been eaten, you must immediately take the appropriate drug. The effect of such a drug is aimed at removing or binding the products of uric acid metabolism.

At the end of the year of treatment, if the person feels satisfactory, there are no relapses, the severe restriction on nutrition is removed.After that, a person can choose whether to adhere to a dietary diet, while the dosage of the drug taken is reduced, or it is completely canceled, or continue to take medications and allow the intake of prohibited foods.

What the treatment is based on

Recently, official medicine has not come up with new methods of treating gouty arthritis. All therapeutic measures are aimed at relieving the inflammatory process. If an exacerbation of the disease has occurred or a person has just learned about its presence, an experienced specialist will prescribe the use of non-steroidal anti-inflammatory drugs.The use of indomethacin, ibuprofen, movalis, rheumoxicam, colchicine is effective (it is a specific anti-inflammatory agent for gouty arthritis).

The treatment of the disease includes the use of indomethacin, dip-rilif, dolobene, remisid. These are ointments based on a non-steroidal anti-inflammatory drug. Also, prescribe the use of lotions, compresses on the floor with an alcohol solution or Dimexide. Therapeutic measures consist not only of drugs, but also physiotherapy procedures (the use of paraffin and other thermal procedures, laser therapy, magnetic therapy, physical therapy complex, massage, gymnastics).

In addition, the patient must comply with a specially prescribed dietary food, as a result of which purine metabolism is normalized, and the use of medications that reduce the synthesis of sodium urate. To completely eliminate the problem, it is necessary to influence its base, namely, an increased level of uric acid. Allopurinol is prescribed (this is a drug that reduces the production of uric acid in the body), probenecid (uric acid crystals are excreted in the urine), uricozyme (sodium urates are destroyed under the influence of this drug).

The first group of drugs includes allopurinol. It is prescribed for high hyperuricemia, frequent acute attacks of the disease. And also if tofuses and kidney dysfunction appear. I show the patient to take the initial dose, which is 300 mg per day. In the absence of effect, the dosage is increased to 500 mg per day. If a significant result is achieved, the dosage is reduced.

To ease seizures, soften tophuses, and normalize uric acid, the patient is prescribed allopurinol.In the first week of use, symptoms may worsen, so it is necessary to combine the drug with an anti-inflammatory drug, a low dose of colchicine or a non-steroidal anti-inflammatory drug. At the initial onset of an attack of gouty arthritis and the lack of experience with the use of allopurinol, it is forbidden to use a remedy to reduce pain.

If we talk about the drugs of the second group, they are less significant in the treatment of the disease.They are not prescribed if the blood contains a large amount of uric acid or renal failure has developed.

To combine various drugs, it is necessary to completely stop an attack of gouty arthritis. Otherwise, another exacerbation will appear. When a patient is prescribed to take medicines that belong to the first or second group, he is warned that the daily intake of water should be at least three liters.

The duration of gouty arthritis varies from 7 months to two to three years. If treatment is interrupted, the risk of relapse increases. If the patient conscientiously adheres to all medical recommendations, the normalization of the condition will occur within the first weeks. In addition, it is necessary to monitor the level of uric acid every month. Based on such indicators, the doctor can adjust the dosage of the drug used. The main therapy is complemented by physiotherapeutic methods, a physiotherapy complex, and massages.

If the patient is overweight, it is necessary to get rid of it. This is explained by the presence of a direct link between gouty arthritis and overweight. In addition, a person should not take thiazide diuretics to lower blood pressure. Under the influence of such drugs, the level of uric acid rises, as a result of which another attack may begin.

If an exacerbation has begun, the stress on the affected joint should be minimized.An additional method is to apply an ice pack for a few minutes. Repeat the procedure three to four times a day.

Thanks
an integrated approach, which includes anti-inflammatory therapy, local
exposure, dietary nutrition, and taking medications that affect
on the metabolism of uric acid, you can get rid of the disease.

Treatment and diagnosis of gout in St. Petersburg. Symptoms, causes.

Gout

Have you started waking up with severe pain at the base of your big toe? Has this area of ​​the foot also turned red, swollen and hot? Then it is most likely gout.Redness and pain are the main signs of gout and should not be taken lightly. With this disease, jokes are bad, because it is terrible with complications.

What kind of disease is this?

Gout is a disease that develops when the metabolism in the human body is disturbed. If the body is prone to accumulation of uric acid and its salts (urates), then the likelihood of gout is very high. Having reached a certain concentration in the blood, uric acid crystallizes.This primarily occurs in the synovial membrane of the joints. The joint loses bearing properties. Thus, gouty arthritis develops.

The first attack is usually very painful. The body temperature during this period can even rise up to forty degrees. When the exacerbation ends, a noticeable enlargement of the joint – tofus (lump or gouty node) remains over the joints of the hands or feet. At first, such nodes are soft, and over time they acquire a dense consistency.

Causes of the development of the disease

Gout develops for two main reasons:

• The body produces an excessive amount of uric acid, as a result of which the kidneys cannot cope with the load;
• Uric acid is within normal limits, but the kidneys are weak.

Additional causes of the disease:

• hypertension, hyperlipidemia, renal failure;
• overweight, diabetes mellitus, stomach problems;
• physical inactivity;
• undergoing anticancer therapy;
• heavy use of alcohol, especially beer;
• heredity.

Diagnosis and treatment of gout

If gout begins, treatment should be started immediately. If you notice the first symptoms, see your doctor right away. After all, the sooner a person consults a doctor, the more chances are to prevent an exacerbation.

The attending physician, after conducting an examination, having studied the analyzes, will explain to the patient how to treat gout correctly. After that, most likely, he will prescribe a certain drug: Allopurinol, Fulflex, Colchicine.

Gout on the feet is a disease that is currently being treated well.Experts are well aware of how to treat gout. Therefore, sometimes you can find ads with the following content: “Effectively treating gout.” The goal of successful treatment is to prevent further build-up of uric acid crystals. This is the task not only of the doctor, but mainly of the patient himself. To achieve a positive result, the doctor prescribes an individually selected medicine. Only a doctor should prescribe a cure for gout. Otherwise, both joints and kidneys can be destroyed. In addition, if gout on the finger is treated unprofessionally, then the joint capsule is completely destroyed.And this means surgery. To prevent this from happening, strictly adhere to the recommendations of a specialist. And most importantly – contact him in time and undergo an examination.

Home treatment for gout

Is it possible to prescribe for gout treatment with alternative methods? Yes, folk methods are sometimes very effective. Therefore, if gout has begun, home treatment will be helpful. But the main thing here is to strictly follow the diet and be sure to first undergo a thorough examination and consult a doctor.Only then will the folk methods do no harm, and the treatment will be directed in the right direction.

If gout occurs on the leg, treatment may be as follows:

• Do foot baths every other day. Then lubricate sore joints with iodine solution (5%). Wrap your legs warmly and go to bed. In the morning, grease the bones with petroleum jelly;
• Honey, heated in a water bath, rub into sore spots, massage, wrap and go to bed;
• Steam your feet until red and dry well.Rub in the Pomorin paste. Perform the procedure at night.

These are just some of the popular ways, but they can bring relief. The main thing is not to be lazy.

Prevention of gout

In order to reduce the risk of an attack, as well as the risk of developing the disease, you need to follow a certain diet. Because a diet for gout is one of the important conditions for successful treatment. Therefore, patients need to exclude certain foods and drinks from their diet.Namely, foods containing purines. These are meat: beef, lamb, horse meat, offal, fish and canned food from them. They also include peanuts, legumes, mushrooms, hot spices, spices, and vinegar. A gout attack can be triggered by alcoholic beverages (especially wine and beer), tea, cocoa, chocolate and coffee. It is necessary to limit the use of pickles, sausages, boiled meat and fish, lard, mushrooms, salt, spinach, sorrel, radish, celery, cauliflower and broccoli.

First signs of gout appeared? Don’t be discouraged, see your doctor, call our medical center and everything will be fine!

90,000 Gout and heart risks

Gout, blood uric acid levels and risk of death: interview with Professor Austin Stack (Ireland).

Could you briefly describe what gout and uric acid are?

Gout is a common disease that affects approximately 4% of the world’s population (1 in 25). Gout occurs as a result of uric acid deposition in the joints, which is caused by elevated levels of uric acid in the blood and is accompanied by painful inflammation.
Although uric acid deposits can affect any joint or soft tissue, swelling usually develops in the joint of the big toe, ankle, or knee.Some patients experience frequent acute attacks of pain, while others may develop so-called. nodular gout – gout in a progressive chronic form. This is due to the buildup of uric acid in the soft tissues.
This form of the disease is becoming more common in Western countries. Recent evidence suggests that gout and hyperuricemia (high levels of uric acid) can be serious risk factors for cardiovascular disease that can be fatal.Therefore, determining the extent of the impact of gout and elevated levels of uric acid on human health is an important task facing modern researchers.

What are the key factors influencing the increase in uric acid levels?
It is widely recognized that elevated serum uric acid levels (hyperuricemia) play an important role in the development of gout in humans. However, not all people with elevated uric acid levels develop gout.
The level of uric acid in the blood may increase, for example, in patients with renal disease, leading to poor excretion of uric acid from the body, or in people who eat excessively rich in purines.
Certain groups of people are predisposed to gout: men, older people, certain racial and ethnic groups; people suffering from obesity, hypertension; organ transplant patients; postmenopausal women; people taking certain medications (loop and thiazide diuretics). People on special diets rich in meat and seafood, as well as consuming alcohol and fruit juices with a high fructose content are also at risk.
It is important for people with regular gout attacks to avoid exposure to these factors.

Why are you studying the combined effect of gout and (increased) uric acid concentration on the risk of death (disease), and why do you think that this issue has not yet been fully understood?
Although there are already a number of publications on the clinical outcomes of gout in large populations and on the role (increased concentration) of uric acid, gaps remain.
Until now, it has not been clear whether the mortality risks associated with gout are increased in patients with elevated blood uric acid levels. In addition, it was not clear whether the risks associated with elevated uric acid levels were the same for people of similar age, sex, race, and disease status.
Our research has contributed to the existing knowledge base and improved our understanding of both uric acid levels in gout and its effects on the body.

What is your research?
We investigated the relationship between gout and serum uric acid fatalities over a 10-year period in 15773 individuals using data from the 3rd National Health and Nutrition Examination Survey (NHANES III).
The section dealing with studies of different groups gave us detailed information on the prevalence of gout, hyperuricemia, cardiovascular conditions and risk factors, and on the types of treatment.The longitudinal component of the study provided us with vital status information up to 2006.
Therefore, we were able to establish the mortality rates (baseline and adjusted) associated with a diagnosis of gout and elevated uric acid levels. As a result, for the first time, we were able to describe the relationship of gout and hyperuricemia with mortality in several age, sex and racial groups, in patients with / without serious comorbidities.
The required analysis (of the data) was carried out by our team at the Graduate Entry School of Medicine at the University of Limerick in Ireland.

What did you find in the end, and what surprised you the most in the study?
There have been some striking observations that have provided new insights into the important roles of gout and hyperuricemia, and have partly confirmed the findings from other published studies.
We found that people with gout died earlier and that their mortality risk was 42% higher overall than people without gout. And the risk of death from cardiovascular disease in gout was even higher by 58%.
We found that patients with gout were more likely and more severely affected by cardiovascular disease than patients without gout (as found in previous studies). When all of these factors are taken into account, the overall risk of mortality in patients with gout and elevated uric acid levels is higher.
By examining most age, sex and race groups, we found that patients with the highest blood uric acid levels (> 375 µmol / L) had a 77% higher risk of dying from all diseases and a 209% higher risk of dying from cardiovascular disease than patients with lower uric acid levels (<256 µmol / L).
We were even more surprised that high levels of uric acid in the blood can harm people who lead a healthy lifestyle. Those who have never smoked (the risk of death is 11% higher with an increase in uric acid levels of 60 µmol / L), who never drank (the risk of death is 15% higher with an increase in urinary acid levels of 60 µmol / L) and physically active people (the risk of death is 9% higher with an increase in uric acid levels of 60 µmol / L).

You were able to find out the reasons why patients with gout died earlier than others, even after adjusting for risk factors such as diabetes, hypertension, etc.etc.?
Our study suggests that gout, cumulative urate severity index, and hyperuricemia were associated with increased mortality risk independently of other known risk factors for cardiovascular disease.
This is strong evidence that hyperuricemia itself may increase the risk of (death from) cardiovascular disease; it can be directly or indirectly related to kidney damage, stimulation and worsening of hypertension, or even systemic inflammation and the development of metabolic syndrome.

What are the key factors that determine the relationship of gout with an increased risk (for) cardiovascular disease?
There is no doubt that, in a certain sense, the relationship between gout and the risk (met with) of cardiovascular diseases can be explained by the presence of additional risk factors in patients. Patients with gout may be more susceptible to obesity, hypertension, diabetes, heart failure, heart attack, stroke, and so on; these factors are closely related to an increased risk of death and cardiovascular risk (ed.)
Indeed, preliminary analysis confirmed that patients with gout quadruple the risk of death and 5 times the risk of death from cardiovascular disease. These findings simply cannot be ignored.
However, after adjusting the data (analysis), the values ​​of these risks will decrease slightly, but will still be significant. This analysis tells us that gout itself can influence the risk of death independently of the usual risk factors we are familiar with.

How important do you think alcohol consumption is in relation to gout and its associated risks?
There is strong evidence that drinking alcoholic beverages (especially beer and spirits) leads to the development of hyperuricemia and gout. Patients who drink excessive amounts of alcohol are at greater risk for a first attack of gout.
Beer poses a higher risk than spirits, and the more you drink, the higher your risk of having a first gouty attack.
While it is possible that alcohol can cause death in patients with gout and elevated uric acid levels, there is some evidence that both gout and hyperuricemia can be fatal on their own. In our study, patients with gout who had never consumed alcohol had a 72% higher risk of death.

What has changed in the treatment of gout and its causes recently?
There are several generally accepted ways to manage gout and hyperuricemia.
In order to prevent gout and the development of its negative consequences, it is necessary to reduce the concentration of uric acid in the blood serum below 300 μmol / l. This method is indicated if patients have recurrent gouty attacks (more than two per year).
Standard therapy usually involves the use of uric acid (level) lowering agents (such as allopurinol), and diuretics are used for preserved kidney disease.
For patients with allopurinol resistance, treatment options were limited until recently.Newer treatments include Febuxostat, a new non-purine xanthine oxidase inhibitor with comparable efficacy to allopurinol. It provides a (dose-dependent) decrease in serum urate levels; a daily dose of 40 mg provides a reduction in uric acid levels approximately comparable to the effect of a 300 mg / day dose of allopurinol.
Another new agent, pegloticase, is an alternative therapy for patients with severe gout who are not responding well to other treatments. Typically, this therapy is used for patients who require a rapid clinical response.
Several professional organizations have developed guidelines for the management of gout, including the European League Against Rheumatism (EULAR), American College of Rheumatology (ACR).

Do you have any recommendations for revising existing approaches to treating patients (with gout)?
One of the most important findings of our study is the identification of a high mortality rate from cardiovascular diseases in patients with gout. We would advise to classify these patients as a group of people with an increased risk of (death) from cardiovascular diseases and to take these risks into account when assessing their condition and during examinations.
Aggressive screening of major cardiovascular diseases and treatment of traditional cardiovascular risk factors are essential. Selective controlled clinical trials are urgently needed to determine whether effective treatment of hyperuricemia and gout results in fewer cases of cardiovascular disease and ultimately a lower risk of death.

What are your further research plans?
Our team leads the way in the number of initiatives to improve our knowledge of cardiovascular disease in large communities.Using existing and newly formed groups, we investigate potential risk factors for cardiovascular disease in specific communities.
For gout and uric acid, we are investigating the relationship between the value of gout and uric acid in different populations and the extent of research and treatment rates in these groups. What should be the target threshold for the treatment of hyperuricemia? Should patients with asymptomatic hyperuricemia be treated?
We are also exploring hypotheses that: 1).elevated uric acid levels lead to poor outcomes in major communities and in those with specific comorbidities; and that 2) there are certain shortcomings in the provision of clinical care to patients with gout and these shortcomings can generally be eliminated by simple intervention.

Where can readers get more information?

There are some excellent online resources for patients and their relatives who may have gout:
http: // www.arthritisresearchuk.org/system/search-results.aspx?keywords=gout
http://www.uptodate.com/contents/gout-beyond-the-basics?detectedLanguage=en&source=search_result&search=gout&selectedTitle=1%7E10&provider=no Original article: http://www.news-medical.net/news/20130726/Gout-uric-acid-levels-and-risk-of-death-an-interview-with-Professor-Austin-Stack-Graduate-Entry -Medical-School-University-of-Limerick.aspx

How to Control Gout uMEDp

Today, gout is considered the most common cause of arthritis.Despite the large number of international and national recommendations for its treatment, the introduction of new anti-gout drugs into practice, the number of patients with chronic tophus gout is not decreasing. The article discusses non-drug and medical methods of therapy for patients with gout.

Table. Factors contributing to the development of gout

Today, of all inflammatory joint diseases, gout is considered the most common cause of arthritis in men and an increasingly common cause of arthritis in women.Its prevalence exceeds that of rheumatoid arthritis. Approximately 0.9–2.5% of European adults, one in 16 Thai adults, and about 4% of Americans are diagnosed with gout. At the same time, in older age groups, the number of patients increases significantly. Thus, in the United States, up to 7% of men over 65 and 3% of women over 85 suffer from gout [1–5].

Unlike other chronic inflammatory joint diseases, the risk factors and pathogenesis of gout are well understood.

It is known that gout is a disease that is caused by the formation of sodium monourate crystals and can develop when the serum uric acid (UA) level is above the saturation point (approximately 404 μmol / L) [6]. The risk of developing gout in both men and women is associated primarily with hereditary factors, as well as environmental factors. The latter include dietary habits, alcohol abuse, taking certain medications, the presence of certain diseases, metabolic disorders and conditions, including metabolic syndrome and its components (obesity, arterial hypertension, dyslipidemia and hyperglycemia), chronic kidney disease, early menopause, etc. …[7-9].

At the initial stage, the disease is clinically intact and is associated with asymptomatic hyperuricemia. During this period, sodium monourate crystals are formed inside the joints and in the periarticular tissues [10, 11]. As a rule, gout debuts acutely – in the form of mono-, less often oligoarthritis. Its manifestations grow rapidly and within a few days (usually up to two weeks) regress until it disappears completely. However, crystal-induced chronic subclinical inflammation and the mechanical effect of conglomerates of uric acid crystals (tophus) on articular cartilage, bone, and surrounding tissues can lead to irreversible damage to joints, periarticular structures, damage to various organs (so-called chronic tophus gout), which is observed with insufficient control over the disease [12-14].

The diagnosis of “gout” is made either when a typical clinical picture of the disease is revealed (in this case, it can be confirmed by the results of ultrasound examination of the joints), or when crystals of sodium monourate are detected by polarizing microscopy, which is recognized as the gold standard of diagnosis [15, 16].

It would seem that the treatment of gout, as well as its diagnosis, especially at an early stage, should not be difficult and an effective treatment strategy aimed at arresting arthritis (if it develops) and lowering the serum MK level to prevent the formation and resorption of monourate crystals can be mastered not only by a specialist rheumatologist, but also by a general practitioner.However, only a minority of patients receive effective care. Most patients have recurrent attacks of arthritis, and tophuses are formed. Despite the large number of international and national recommendations for the treatment of gout, the introduction of new anti-gout drugs into practice, the number of patients with chronic tophus gout is not decreasing [5, 14, 17, 18]. Suboptimal patient care is named among the reasons. As a result, there are unfavorable outcomes of the disease, which predetermine the negative perception of gout by both patients and their curators [19].

We have to admit that doctors often focus on the treatment of acute attacks of arthritis. They do not consider gout as a chronic progressive disease, so either they do not prescribe urate-lowering drugs, or they are prescribed in the wrong dose.

It is possible to overcome the current situation and prevent the development of severe forms of the disease through appropriate training of doctors and patients.

When prescribing treatment, attention should be paid to modifiable risk factors for hyperuricemia.We are talking, in particular, about obesity, high blood pressure, alcohol consumption, and some food products. Diuretics, salicylates, nicotinic acid, cyclosporin A, and other drugs also increase the likelihood of developing gout. Therefore, they should only be prescribed when absolute readings are available.

Regardless of the stage of the disease – from asymptomatic hyperuricemia to chronic tofus gout – all patients should be given advice on adherence to a low-purine diet and lifestyle.

With regard to non-pharmacological methods of treatment and prevention of gout, the European League Against Rheumatism (EULAR) in 2006 recommended providing patients with information about the disease and its treatment, assessing comorbidities, reducing weight and calorie intake, and limiting alcohol consumption. The 2014 additions discourage drinks with a high fructose content (such as corn syrup), alcoholic and non-alcoholic beer (due to the high concentration of purines) and spirits, while one or two servings of dry wine are intact in this regard [20, 21].Unlike meat (especially red meat, wild animals and offal), seafood (shellfish, fish), the risk of gout is not increased by purine-rich legumes, mushrooms, asparagus, and oatmeal [22]. Coffee consumption is inversely correlated with serum MK levels and is associated with a decrease in the risk of developing gout regardless of its caffeine content [23–25]. Data on the relative risk of various factors influencing the development of gout are presented in the table [26, 27].

It has been found that skim milk, including dry milk, reduces the frequency of arthritis attacks [28].An unreliable decrease in serum MK levels is observed when two doses of green tea extract are taken [29].

Often, patients with gout use food supplements and vitamin complexes both for the treatment of arthritis and for lowering serum MC levels. In a study by E. Chan et al. such turned out to be 66 (23.9%) out of 276 [30]. The use of alternative and complementary methods increased the cost of treatment fivefold, but after a year of follow-up, a comparison of the results in the groups of standard therapy and standard therapy in combination with the alternative showed no differences in indicators reflecting the quality of life, the frequency of arthritis attacks, and the level of MC in the blood serum.

However, non-drug therapy alone is not enough for such patients. Thus, a survey of 160 men with gout, carried out on average seven years after the first visit to the doctor, showed that none of the 19 patients who did not take urate-lowering drugs, but followed the recommendations for lifestyle modification and diet (low purine content), did not reached the target blood MC level [14].

It should be noted that there are no data on the effectiveness of alternative treatments for acute arthritis in gout, with the exception of cryotherapy (low level of evidence) [31].

Drug treatment is aimed at solving three main tasks: arresting an attack of arthritis, reducing serum MC levels to the target level, and preventing arthritis attacks in the first months of taking urate-lowering drugs.

Treatment of an acute attack of arthritis in gout is desirable to begin in the first 24 hours, which allows rapid relief of symptoms [32]. For this, non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, glucocorticosteroids (GCS) and interleukin 1 inhibitors are used [31, 32].

NSAIDs are considered first-line drugs. They should be used at the maximum daily dose and stopped one to two days after the symptoms of arthritis have subsided. It is advisable to prescribe drugs with proven efficacy for acute pain. In terms of effectiveness, injectable forms are not superior to oral ones [31, 32].

Most comparative studies have shown comparable efficacy for a number of NSAIDs. At the same time, the results of a large randomized trial [33] demonstrated that nimesulide at a dose of 200 mg / day, in contrast to diclofenac sodium at a dose of 150 mg / day, more quickly relieves the symptoms of arthritis in gout and can be effective even in patients with negative experience of taking others. NSAIDs, oligo- and polyarthritis, arthritis lasting more than three months [34].

The most commonly used nimesulide and patients with gout, independently, without a doctor’s prescription, using NSAIDs to relieve arthritis attacks [35].

According to experts, the effectiveness of nimesulide in acute pain, when inflammation is the predominant component, can be explained by the rapid onset of analgesic action – 15 minutes after ingestion. The latter is due to the fastest possible release of the drug due to the granular form of release.In addition, nimesulide has a good safety profile. The foregoing suggests the possibility of widespread use of the drug for the treatment of acute pain [36].

Colchicine can be an alternative to NSAIDs. In Europe (with the exception of France), it is inferior to NSAIDs in terms of frequency of use and popularity. On the first day, colchicine is taken at a starting dose of 1 (1.2) mg, an hour later – another 0.5 (0.6) mg, then – 1 (1.2) mg per day in one or two doses [31, 32 ]. Treatment with colchicine should be started as early as possible, because, unlike NSAIDs, it does not have a direct analgesic effect and its effect 72–96 hours after the onset of symptoms is often insufficient.In addition, taking even low doses of colchicine is often accompanied by nausea, diarrhea, and vomiting [31, 32]. The drug has no gastrotoxicity and is safe for patients with cardiovascular diseases. However, while taking colchicine, myopathy may develop (more often when using high doses, when used together with statins, fibrates, verapamil, diltiazem, cyclosporine, macrolides, etc.). Among the severe adverse effects of therapy, neuropathy, cytopenia (thrombosis, leuko-, pancytopenia, aplastic anemia) and disseminated intravascular coagulation syndrome are also indicated [37–40].

In elderly patients with liver pathology, renal insufficiency, the drug should be used with caution, and if the glomerular filtration rate is less than 10 ml / min, its use is contraindicated [41].

If NSAIDs and colchicine are contraindicated, GCS is used [41]. In an acute attack of arthritis, GCS are used at a dose of 30–35 mg for three to five days, then they are canceled or taken for several days (up to 10–14 days) at a low dose to reduce the risk of relapse.The effectiveness of GCS is not higher than that of NSAIDs, while the frequency of adverse reactions is comparable (35 mg / day of prednisolone versus 1000 mg / day of naproxen) [42]. In monoarthritis, intra-articular injections of corticosteroids are preferable due to the lower safety profile of drugs [31]. At the same time, according to a number of studies, the risk of developing disorders of carbohydrate metabolism and cardiovascular diseases even with a short course of GCS or intra-articular administration is underestimated [43, 44].

If it is impossible to use GCS, it is advisable to prescribe interleukin 1-beta inhibitors.In some European countries, including the Russian Federation, the drug canakinumab is registered. It is indicated for patients with severe chronic gouty arthritis resistant to other anti-inflammatory therapy, or with concomitant diseases limiting the intake of NSAIDs, GCS and colchicine, in the absence of a current infection [45, 46].

The effect of canakinumab exceeds that of corticosteroids and colchicine, while it lasts for two to three months. This period is optimal for the appointment of urate-lowering drugs, since each of them, regardless of the mechanism of action, in the first months of use increases the risk of new attacks of arthritis [47].

Therapy with urate-lowering drugs is necessary for almost all patients with gout: with relapses of arthritis, the presence of tophi, urate arthropathy and / or kidney stones. Patients under 40 years of age with very high serum MC levels (more than 480 μmol / L) and / or with comorbidity (renal failure, arterial hypertension, ischemic heart disease, heart failure) should be prescribed it immediately after diagnosis.

The first line drug is allopurinol.The drug has been used to treat gout for 50 years, so it has been fairly well studied. Allopurinol therapy begins with a dose of 50-100 mg / day, every two to four weeks the dose is increased by 50-100 mg until the target MC level is reached (

The effect of allopurinol is dose-dependent; therefore, low doses (≤ 300 mg / day) allow reaching the target MC level only in one third or half of cases. In most cases, the use of high doses (up to 900 mg / day) is justified, including economically [14, 49], although such therapy is associated with a high risk of adverse events, especially severe skin reactions.

The drug should be used with caution in the presence of chronic kidney disease. It should be noted that in several studies titration of the dose of allopurinol significantly higher than the recommended dose based on a decrease in the glomerular filtration rate allowed, firstly, to achieve the target level of MC in the blood, which was not observed when using a limited dose, and secondly, did not lead to an increase in the frequency severe adverse reactions [50, 51]. The effectiveness of allopurinol in slowing the progression of chronic kidney disease has not yet been proven and appears to be minimal [51, 52].The possibility of using high doses of allopurinol in these patients is currently widely discussed [53], and some recommendations for the treatment of gout allow it [21].

Recent data confirm that long-term use of allopurinol for gout has a beneficial effect on long-term prognosis, probably due to a decrease in cardiovascular risk: the cumulative incidence of death in patients taking allopurinol was 19% less [54].

For chronic kidney disease, another xanthine oxidase inhibitor, febuxostat, should be preferred.The drug has been used in most countries since 2009. It is more effective and safer with a moderate decrease in glomerular filtration rate [55, 56]. Febuxstat is prescribed in a dose of 40 to 120 mg / day; slow titration of the dose, as with the appointment of allopurinol, is not required. This, on the one hand, allows you to quickly achieve the desired effect – a decrease in serum MK levels and dissolution of its deposits (tofuses), on the other hand, there is a high probability of exacerbations of arthritis in the first months of therapy.

Standard doses of febuxostat are more effective than allopurinol in reducing uricemia (target level is achieved more often), including in patients with chronic kidney disease [55–57].The cardiovascular safety profile of the drug has not yet been studied.

The third line of therapy is intravenous infusion of pegloticase, a uricase preparation, an enzyme that metabolizes MK to safe allantoin. The drug, used for resistance to any other treatment, is administered every two weeks. The cost of one injection exceeds USD 5,000, which limits the possibility of its widespread use [58].

In case of insufficient effectiveness of xanthine oxidase inhibitors, it is possible to prescribe uricosurics (benzbromarone, probenecid, lezinurad), including in combination with xanthine oxidase inhibitors.With asymptomatic hyperuricemia, the appointment of urate-lowering drugs is unjustified. It should be limited to therapy aimed at correcting risk factors.

Since the risk of arthritis increases at the start of any urate-lowering drug [59], prophylactic anti-inflammatory therapy with colchicine or low-dose NSAIDs given the risk of adverse events should be considered in the first six months of treatment [60].

90,000 Allopurinol for chronic gout | Cochrane

Review question

This Cochrane Review summary presents what we know from research about the effects of allopurinol in people with chronic gout, compared to placebo or other treatments that lower uric acid levels.This review is current to January 2014.

Relevance: What is chronic gout and what is allopurinol?

Chronic gout is a common variant of inflammatory arthritis associated with high levels of uric acid in the blood, leading to the formation of crystals in the joints. Allopurinol is a medicine that helps lower the level of uric acid in the blood.

Characteristics of research

After searching for all relevant studies, we found 11 studies that included 4531 adults with chronic gout.Two studies compared different doses of allopurinol (ranging from 100 to 300 mg per day) with placebo; four studies compared allopurinol with febuxostat; two studies compared allopurinol with benzbromarone; one study compared allopurinol with colchicine or probenecid. Two studies compared different therapeutic doses or routes of administration for allopurinol. We looked at allopurinol versus placebo as the main / main comparison and present the full results below.

Key findings

Allopurinol 100 to 300 mg daily versus placebo

Acute attacks of gout

– 4 fewer out of 100 people had an acute gout attack with allopurinol at a dose of 100 to 300 mg per day, compared with placebo ( 4% absolute decrease).

– 8 out of 100 people taking allopurinol had an acute attack of gout.

– 12 out of 100 people taking a placebo had an acute gout attack.

Proportion of participants who achieved target serum urate levels

– 96 more out of 100 people in the allopurinol group reached the target serum urate level (96% absolute increase).

– 96 out of 100 people taking allopurinol achieved target serum urate levels.

– 0 out of 100 people taking placebo achieved target serum urate levels.

Dropping out / refusing treatment due to adverse events

– 2 more out of 100 people in the allopurinol group dropped out due to adverse events (2% absolute increase).

– 6 out of 100 people taking allopurinol dropped out due to adverse events.

– 4 people out of 100 on a placebo dropped out due to adverse events.

Serious adverse events

– 1 more person out of 100 in the allopurinol group had serious adverse events (1% absolute increase).

– 2 out of 100 people taking allopurinol have had a serious adverse event.

– 1 in 100 people taking a placebo had a serious adverse event.

Pain, function and reduction of arthritic deposits in joints have not been reported in sufficient detail to represent these results.

Quality of evidence

In people with chronic gout, moderate-quality evidence indicates that allopurinol (100 to 300 mg daily) compared with placebo probably does not reduce the number of acute gout attacks, but increases the frequency of reaching target serum urate levels without increasing the frequency dropouts due to adverse events or serious adverse events.Further research may change these estimates. Pain and reduction in gouty deposits were not reported in sufficient detail to allow group differences to be counted. [Joint] function was not assessed / measured.

Low quality evidence indicates that allopurinol (100 to 300 mg per day) compared with febuxostat (80 mg per day) in people with chronic gout may not reduce the incidence of acute gout attacks, and may be less effective in achieving target serum urate levels without increasing the dropout / withdrawal rate due to adverse events or serious adverse events.Further research is likely to change these estimates. The reduction in gouty joint deposition was not reported in sufficient detail to allow for group differences to be counted. Pain and function were not measured / evaluated.

Allopurinol (up to 600 mg per day) versus benzbromarone (up to 200 mg per day) in people with chronic gout may not reduce the incidence of acute gout attacks (low-quality evidence), and probably does not increase target achievement serum urate, or dropout / refusal rate due to adverse events (moderate quality of evidence).Further research may change these estimates. Reductions in arthritic joint deposition were not reported in sufficient detail to allow differences between groups to be counted; pain and function were not evaluated / measured.

The quality of the evidence was downgraded due to limitations in study design indicating potential bias and possible imprecision. All other comparisons were supported only by small, single studies, leading to limited conclusions.

Gout salmon. Gout and food

Certain foods are known to exacerbate certain diseases, such as gout, and doctors advise patients to avoid these foods. With gout, which is caused by the accumulation of sharp, like a needle, uric acid crystals in the tissues of the body and manifests itself as an extremely painful inflammation of the joints in the form of gouty nodes, it is undesirable to consume foods that cause an exacerbation of the disease.It is known that with gout, the big toe, as well as knee joints, ankles and joints on the hands, are most commonly affected. Exacerbations or outbreaks of the disease can last from several days to several months. Obese men and people are at greater risk of developing gout. If you’re prone to gout, the food you eat (or don’t eat) plays a big role in keeping your joints healthy.

Here are a few foods that can affect the development of gout or, conversely, avoid its aggravation.

Scallops

Nutritionists at Southwestern Medical Center at the University of Texas at Dallas say cut back on seafood and meat during an outbreak. These animal foods contain purines, which are converted to uric acid in the body. During the remission period, you have a little more freedom in your choice of food, but during this period it is best to limit yourself to small portions of meat and seafood: about 110 to 180 grams per day.

Scallops and salmon can be good choices to indulge your desires during a lax diet.

Herring

Although some seafood can be consumed occasionally in small quantities, others should be completely excluded from the menu of people suffering from gout. For example, you need to completely exclude from your diet such types of marine fish as herring, tuna, anchovies.

Seafood such as shrimp, lobster, eel and crabs are relatively safe and can be consumed in reasonable amounts.

Beer

For people suffering from gout, drinking beer is a double whammy, as it not only increases the level of uric acid, but also prevents the elimination of this substance from the body.

Wine will be the best choice, but drinking is a bad idea for all people, and those with gout are no exception. During an exacerbation, doctors generally recommend that you completely abstain from drinking any alcohol.

Red meat

When it comes to purines, you need to know that in this respect, different types of meat are very different.White meat is generally better than red meat, but it is normal to consume small amounts of certain types of red meat even during flare-ups.

For example, if you want to eat a piece of meat, it is best to try some beef or pork rather than turkey or lamb. But it’s also worth knowing that in the case of lamb, a lamb chop is a better choice than a leg.

Turkey

Turkey and goose meat contains more purines than other poultry, so it is best to avoid eating them.People prone to gout should also minimize their game consumption.

Nutritionists believe that chicken and duck are the safest choices. However, leg meat is a significantly better choice than skinned chicken breasts.

Sweet drinks

Avoid high fructose corn syrup sweetened sodas, such as non-diet sodas or fruit drinks. Not only are these drinks an easy way to put on extra pounds: you need to know that sweeteners stimulate the body to produce more uric acid.

A study found that men who consume a lot of fructose are more likely to develop gout, and that daily consumption of fructose sweetened beverages by women significantly increases their risk of developing gout compared to women who consume less than one sweetened soda per month.

Asparagus

Asparagus, cauliflower, spinach, mushrooms contain more purines than other vegetables. But if you love these foods, there is no reason to completely avoid consuming them.Of course, vegetables containing purines should not be overused, but they do not pose the same problem as meat.

A diet rich in vegetables actually helps to remove purines from the body, although it is known that the body can more easily absorb purines from plant sources.

Liver

Meat such as liver, kidney, and liver is a staple product worth saying a resounding no.

What can you eat?

Do you think that you are left with practically nothing? This is not true.

There are several types of foods that help protect you from gout. These are low-fat dairy products, complex carbohydrates, coffee and fruits, especially citrus fruits. You should also make sure to drink 12 to 16 cups of liquid a day.

You don’t have to drink only water (although it doesn’t have to be beer!), You can drink fresh unsweetened juices, tea and coffee.