Gout is a form of inflammatory arthritis that can cause intense pain and swelling in the joints. This condition develops when high levels of uric acid build up in the body, leading to the formation of sharp crystals within the joints. For many individuals, the question arises: can gout truly “go away forever”? While a complete “cure” by eliminating the underlying metabolic tendency is not currently possible, gout can be effectively managed and put into a state of long-term remission with proper treatment and consistent management.
Understanding Gout
Gout occurs when there’s an excess of uric acid in the blood, a condition called hyperuricemia. Uric acid is a natural byproduct formed when the body breaks down purines, substances found in many foods and body tissues. Normally, uric acid dissolves in the blood and is filtered out by the kidneys. However, if the body produces too much uric acid or the kidneys do not excrete enough of it, levels can rise, leading to the formation of urate crystals.
These crystals can accumulate in joints and surrounding tissues, triggering inflammatory attacks. Gout attacks often strike at night, causing intense pain, redness, swelling, and warmth in the affected joint. The big toe is a common site for these attacks, but gout can also affect other joints like the ankles, knees, elbows, wrists, and fingers.
Managing Gout
Treating gout involves two main strategies: addressing acute attacks and lowering uric acid levels to prevent future flares. During an acute gout attack, the goal is to reduce pain and inflammation quickly. Common medications include nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, colchicine, and corticosteroids, which can be taken orally or injected. These medications work to quell the inflammation caused by the crystals.
For long-term management, uric acid-lowering therapies (ULT) are used to reduce and maintain uric acid levels. Medications like allopurinol and febuxostat block uric acid production, while probenecid help kidneys excrete more uric acid. Lifestyle adjustments include avoiding foods high in purines (like red meat and seafood), limiting alcohol intake, staying well-hydrated, and managing weight. While diet alone cannot control gout, these adjustments complement medical treatment to reduce uric acid levels.
Achieving and Maintaining Gout Remission
While gout cannot be “cured” by eliminating the underlying metabolic tendency, it can be put into a state of remission. Remission in gout means the absence of gout flares and sustained lower uric acid levels. For most individuals, the target serum uric acid level is below 6 mg/dL, though for those with tophi or frequent attacks, a target below 5 mg/dL may be recommended to help dissolve existing crystals. Achieving remission requires consistent adherence to uric acid-lowering medications and lifestyle modifications.
This state signifies that disease activity is controlled, allowing individuals to live without debilitating gout symptoms. The process of dissolving existing crystals can take time, sometimes up to two years, even with effective ULT.
Living with Gout Long-Term
Long-term gout management involves ongoing vigilance, even without symptoms. Regular monitoring of uric acid levels ensures they remain within target range, typically every 6-12 months once stable. Continued adherence to uric acid-lowering medication is often necessary indefinitely, as stopping treatment can lead to a recurrence of attacks.
Sustained lifestyle modifications, including a balanced diet, adequate hydration, and maintaining a healthy weight, help prevent future flares and support overall health. If gout is not well-managed over time, it can lead to complications such as permanent joint damage, hard uric acid deposits called tophi under the skin, and kidney stones. Untreated gout also increases the risk of chronic kidney disease.