Scott Webb (Host): Gout is a common inflammatory condition that affects our joints and my guest today wants us to know that we definitely don't want gout and should seek medical attention as quickly as possible if we believe we have gout. I'm joined today by Dr. Jaqui Jones. She's a Family Medicine Doctor with PRISMA Health.

 This is Flourish, the podcast brought to you by PRISMA Health. I'm Scott Webb.

Doctor, thanks so much for your time today. We're going to talk about gout. And I was thinking about, as I approached this topic, that I don't often talk about gout. You probably do, but I don't, but it's great to have you here. Great to have your expertise. Let's start with the most obvious questions here. What causes gout and is it a serious condition?

Jaqui Jones, MD: Well, first, let me say thank you for having me. And I do talk about gout all the time in my office. So, you know, gout is really the most common inflammatory arthropathy in the United States. And for those who do not know what an arthropathy is, it is a disease or inflammation of the joint. I think we most commonly know of them, under the umbrella is arthritis.

So arthritis is an arthropathy and gout is as well. And gout is actually the most common inflammatory cause in the United States.

Host: Yeah. And I was going to just follow up, we were saying before we got rolling here that we can kind of, you know, have a little bit of a smile on our voice when we talk about gout, because perhaps not the most serious thing in the world, but is it actually a serious condition?

Jaqui Jones, MD: So it can be a serious condition. We know that long term or repetitive episodes of gout can lead to some joint deformities and they can be painful. So, you know, if you have tophi, which we can get into a little bit later, the movement of that joint, the range of motion can be impacted and pain and things such as your toes or your fingers can really impact how people operate day to day.

Host: Yeah, it can definitely affect your quality of life. And as you're saying, you know, if people have it a lot, it could lead to deformities, worst case scenarios. Like, I've never had gout before and I don't know if I've ever known anybody who has that.

Jaqui Jones, MD: You don't want it.

Host: I don't want, yeah, I definitely don't want it. Right. So is it a thing where just about anyone can be affected by gout or are there maybe behavior, lifestyle, genetic factors that put you at higher risk?

Jaqui Jones, MD: So a little bit of everything. So anyone can be affected by gout, but there are some groups that are at higher and lower risks. So premenopausal women tend to have lower risk because they tend to excrete more uric acid out in the urine and elevated uric acid levels are the cause of gout, but as you get older, the risk of gout increases.

So, as you get older and you're the right gender, meaning male, you have a higher risk. For example, an 80 year old male tends to have a 12 percent higher risk of having gout than the standard population. There are also lifestyle choices that can impact this. Moderate to excessive consumption of alcohol, meat, fructose items can all tend to increase your risk of episodes of gout.

Host: So all the good stuff, right?

Ha

Jaqui Jones, MD: I know, we're all vulnerable, because who does not love some alcohol? You know, we're fresh off of a holiday, so I'm sure there was alcohol and meat consumed at barbecues everywhere, so we all were probably at a little bit of a risk for gout.

Host: Yeah, so as you say, it's some behavior, lifestyle, maybe more male than female, that kind of thing. How do you know, like I said, I've never had gout. How do you know if, like, I know that I have osteoarthritis, you know, pretty much everywhere. But, uh, how does one know if they have gout?

Jaqui Jones, MD: So, you know, I think gout is unforgettable. You'll get a rapid development of redness, pain, and swelling in a particular joint. The most common joint is the large toe. It is fast, it happens suddenly, the joint is painful. It's tender to the touch. When people come in, they say, I think I have gout. I can just touch it a little bit. And it is immediately like painful to them. And that is a really good indication that you have gout from a visual clinical standpoint.

Host: You're right, yeah, maybe not much patient history or examination needed, all you have to do is kind of touch that big toe, right?

Jaqui Jones, MD: And people will know. I also want to point out that from a diagnostic criteria, you know, many things inflame our joints. We just talked about you have osteoarthritis. I have a little bit too. But gout is very specific that you inflame one joint at a time. Not tons of joints. So if someone came in and they said, my toe hurts, but my finger hurts as well.

And my shoulder, by the way, and they all started at the same time. I would say, Hey, maybe this isn't gout. Maybe we need to consider other inflammatory processes and make sure that we have the right diagnosis. But when we're talking about gout, it is that sudden painful, red, beefy joint for just one joint.

Host: Yeah, and it seems, Doctor, that it's almost always, you mentioned the big toe, right? That it seems like it's usually associated with the big toe or feet in general, but is it only people's feet?

Jaqui Jones, MD: So it is not. The big toe, right? Everybody knows it. Oh, I got gout in my toe. Everyone knows it from that standpoint, but actually other joints can be impacted. So whether that be fingers, wrists, ankles, knees even. I've seen it in a knee a couple of times. All joints can be affected by gout.

Host: All right, so gout is an equal opportunity offender, if you will.

Jaqui Jones, MD: Yes.

Host: All right, so it sounds like gout is fairly common, especially based on the risk factors that most of us enjoy, like a good piece of meat, so how do you treat gout? And is it the type of thing that is cured or is it always there kind of bubbling under the surface?

Jaqui Jones, MD: When someone has an acute gout flare, we would like to start treatment within 24 hours of that onset. We use a couple of different medications, are a great tool. So we can use anything from a corticosteroid to an NSAID or a medicine called colchicine. They all typically have really good responses and rates and resolve the symptoms. Our first line is always the NSAID in a medicine called indomethicin, but if someone had problems with their kidney function or just could not tolerate them, maybe they've had a surgery that means that they cannot have these medications, maybe they have heartburn and so NSAIDs are not really a good idea.

I think that the corticosteroids are a great option and they all have been very effective in controlling symptoms. We like to start those medications and continue them till one to two days after symptoms have resolved, just to make sure everything is completely treated. So nothing worse than having gout one time than to get it again. So we want to make sure that we have treated the pain and treated the symptoms and the joint has come back down to normal.

Host: Yeah. And how do we prevent future flare ups? Is it, we just stop eating and drinking all the good stuff? You know, it just, just really limit our diet, beverage and food and otherwise? Or can folks take medicines if they're prone to flare ups of gout? Can they take this sort of course of to prevent it?

Jaqui Jones, MD: Sure, well let me first talk about who we recommend for preventative therapies because I don't want everybody to run and say, I remember one time last year I had gout, do I need it? So, typically anyone who has had gout plus two flares per year, we'll take just one flare per year if you have like chronic kidney disease, stage 2 or greater or if you have what we call tophi or a history of kidney stones.

So this is the second time I mention tophi, so I just want to clarify what is tophi. Tophi happens when you get so many episodes of gout in a particular joint that it actually starts to make your joint numb. kind of bumpy and nodular. So you can actually feel the joint gets really large and kind of chronically swollen and inflamed and does not go down.

We call that tophi. So if you have tophi or kidney stones, if you get multiple flares a year, that's a good reason to consider preventative therapies. For prevention, we're really trying to just lower your uric acid levels to decrease the chances that you develop crystals in your joint. And we've got two approaches. One is a medication standpoint. So we like to give people medications that decrease just how much uric acid they produce. And also lifestyle modification. So yeah, here comes the un fun part. So we know that weight gain can increase the risk of flares. And we also know that food choices can increase the risk of flares.

So decreasing your purine rich animal products such as organic meats, beef, lamb, shellfish, beer, also juices and food items that have a high amount of fructose in it can all be decreased or sometimes eliminated to prevent future attacks.

Host: Yeah, it's really interesting, been really educational. Gout's one of those things where I'm like, yeah, I probably know enough about gout. And then you talk to an expert and you go, yeah, you know what? There's a lot I didn't know about gout. Yeah. And, definitely learning from you today that we, we don't want it.

And we don't want to leave it untreated. So let's just finish up there, Doctor. Just worst case scenario. I told you before we got rolling, we wouldn't do any doom and gloom, but here we are at the end here, a worst case scenario, if folks can somehow tolerate the pain, which it sounds awfully painful, but if they can somehow tolerate that and go on about their lives, what's the worst case scenario if they ignore those symptoms?

Jaqui Jones, MD: So, you know, I think if you have a single flare and you can push through, then I don't think that long term there are lots of risks, but if you are someone that seems to have a flare multiple times a year and you've done that for a long time, I think the risk of the damage to the joint. So the tophi really is what I think about the use of the joint.

Are we going to maintain your range of motion? Are we going to maintain the full function? Is it going to be disfiguring, right? So tophi really is visible. You can see it across the room. So someone who has a large thumb that seems to be super bumpy at the joint is gonna be impacted by the form and the function.

So I think that that is what's at risk. Form and function of your joints are always at risk. And as a family medicine physician, I happen to be very committed to form and function because I know that people's autonomy is really important. And so I think of those things as the long term effects, which is why I'm always encouraging people to just have it checked out.

Host: Yeah, for sure. To me, I'm listening to you thinking, well, there's no way if I thought I had gout, now that I know the signs and symptoms from you, there's no way I wouldn't go see my doctor because it just sounds awful and painful and I definitely don't want it again. But we hope, the listeners had the same reaction to that, right? Heeding your advice and your expertise. Thank you so much for your time.

Jaqui Jones, MD: Thank you so much. Thank you for having me.

Host: For more information and other podcasts just like this one, head on over to prismahealth.org/flourish. This has been Flourish, a podcast brought to you by PRISMA Health. I'm Scott Webb. Stay well.