Gout Awareness

By Kent Bressler, AAKP BOD/Ambassador, Kidney Transplant Recipient

The old adage, which came first the chicken or the egg, kind of explains how it is with gout. Do you get gout from kidney disease or can kidney disease cause gout? For our purposes, let’s just say if you are a kidney disease patient or have had a kidney transplant your chance at having a gout attack is relatively high. Gout has been part of my kidney life for over forty years, and in my experience, it has been one of the most difficult and painful parts of living with kidney disease and maintaining a viable kidney transplant.

My main source, the Mayo Clinic, describes gout as a type of arthritis that causes inflammation of joints and is due to excess uric acid in the joints. There are more than 200,000 cases per year in the U.S. Gout is diagnosed by lab tests that measure uric acid levels and can involve joint fluid test, blood test or imaging test (such as x-rays or ultrasounds). For a confirmed diagnosis the joint can be aspirated to provide a sample from the involved joint. Aspirating for uric acid crystals is important because if there are no uric acid crystals there is no gout. If there are calcium crystals in the joint then it is called Pseudo gout. Not much difference here in the pain and aggravation and the therapy is similar.

Unfortunately there is no known cure for gout but there are treatments that can control it. It is not uncommon to have a gout attack that lasts for days and in some cases can go on for weeks. The good news is that there are good effective treatments for the pain.

In all of the articles I have read, and from my own life experiences, the symptoms include sudden severe pain and swelling in the joints usually in the big toe. The trouble is, gout can and does affect all joints, ankles, toes, wrists, elbows and knees, and I have had it in nearly all of my joints. The pain is intense, as if you are being stabbed with a hot poker. The pain is relentless and will NOT subside until treated, and trust me, the sooner you get it treated the better. The pain is generally accompanied by severe inflammation, swelling and/or redness to the affected joint as referenced in the pictures below. Gout is NOT fun and it can be extremely debilitating.

Treatment of gout is physician driven, you should NOT treat yourself. Ongoing, chronic, untreated gout can also damage your kidneys. If you have had a transplant, it is even more important that you aggressively treat it. Treatments vary by patient and must involve changes in your life style and the use of medications.

Lifestyle changes usually center around your diet since some foods have been thought to trigger a gout attack. The biggest culprit are foods containing purines. According to the Artihritis Foundation, purines are a type of chemical compound found in foods and drinks that are part of a normal diet. A small number of foods contain concentrated levels of purines, such as seafood, organ meats and alcoholic beverages, especially beer.

Identifying and eliminating the high purine foods is important in staving off gout attacks but it is not enough to eliminate them. My brother, who was my kidney donor, has had gout attacks and he can pin point the attacks to eating asparagus. What does asparagus have in it. You got it “purines”. You will not find any asparagus in his garden! There is a caviat here, high purine foods eaten to excess or in large amounts could initiate attacks of gout. The trouble is, you don’t know what an excessive or large amount is as it is different for different folks. It is best to moderate their use or steer clear of them all together and that would be your choice. The second course of treatment is with medications. Physician prescribed Cholchicine, Corticosteroids and Nonsteroidal anti-inflammatory durgs (NSAIDs) are used for short term acute gout attacks and help to reduce pain. CAUTION, kidney disease and transplant patients need to steer clear of NSAIDs as they are nephrotoxic. Make sure you challenge any presciption or recommendation for NSAIDs. Remind your physician if you have kidney disease or have been transplanted, most will not recommend them. Fear not, there are plenty of alternatives.

Long term maintenance drugs for controlling uric acid levels are the next step and this may include Allopurinol and Febuxostat; Probenecid and Lesinurad; and PegloticaseI have been on Allopurinol for four decades. In the past ten years there has been an explosion in the development of new medications to lower uric acid. Best advice is find a doctor who is well-versed in gout or arthritic conditions.. Ask your nephrologist to refer you – Ibet he knows just the right specialist!

Self care for acute attacks is ice and elevation. Remember Gout is dangerous, treat it early and monitor it closely.

For more information on gout check out the following resources:
AAKP Understanding Gout in Kidney Disease
AAKP HealthLine webinar: What You Need to Know about Gout
Alliance for Gout Awareness
Gout Revealed
Gout Education Society
Visit the AAKP education web page on Gout