From the Guidelines
Self-management of gout should prioritize lifestyle modifications, including weight loss, avoidance of alcohol and sugary drinks, and a diet low in purine-rich foods, as well as adherence to prescribed urate-lowering therapy and anti-inflammatory medications. According to the 2016 updated EULAR evidence-based recommendations for the management of gout 1, every person with gout should receive advice regarding lifestyle modifications, including weight loss if appropriate, avoidance of alcohol (especially beer and spirits) and sugar-sweetened drinks, heavy meals, and excessive intake of meat and seafood. Low-fat dairy products should be encouraged, and regular exercise should be advised.
Some key strategies for self-management of gout include:
- Maintaining a healthy weight through regular exercise
- Limiting consumption of purine-rich foods like red meat, seafood, and organ meats
- Reducing alcohol intake, especially beer
- Avoiding sugary beverages
- Staying well-hydrated by drinking 8-10 glasses of water daily to help flush uric acid from the system
- Taking prescribed medications like allopurinol or febuxostat to lower uric acid levels consistently, even when not experiencing symptoms
- Applying ice to the affected joint for 20-30 minutes several times daily to reduce pain and swelling during an acute attack
- Resting the joint and elevating it when possible during an acute attack
It is essential to note that the management of gout should be individualized, and patients should be fully informed about the pathophysiology of the disease, the existence of effective treatments, associated comorbidities, and the principles of managing acute attacks and eliminating urate crystals through lifelong lowering of serum uric acid (SUA) level below a target level 1. Regular monitoring of uric acid levels through blood tests is crucial, and patients should consult their doctor if attacks become more frequent or severe, as medication adjustments may be necessary. The American College of Physicians guideline on the management of acute and recurrent gout also emphasizes the importance of lifestyle modifications and adherence to prescribed medications 1.
From the FDA Drug Label
The dosage of allopurinol tablets to accomplish full control of gout and to lower serum uric acid to normal or near-normal levels varies with the severity of the disease. A fluid intake sufficient to yield a daily urinary output of at least 2 liters and the maintenance of a neutral or, preferably, slightly alkaline urine are desirable. Clinical experience suggests that patients with recurrent calcium oxalate stones may also benefit from dietary changes such as the reduction of animal protein, sodium, refined sugars, oxalate-rich foods, and excessive calcium intake, as well as an increase in oral fluids and dietary fiber
Self-management of gout involves:
- Taking allopurinol as directed by a healthcare provider to lower serum uric acid levels
- Maintaining a fluid intake of at least 2 liters per day
- Keeping a neutral or slightly alkaline urine
- Making dietary changes such as reducing animal protein, sodium, refined sugars, oxalate-rich foods, and excessive calcium intake, and increasing oral fluids and dietary fiber 2
From the Research
Self-Management of Gout
- Gout is a form of inflammatory arthritis characterized by swelling, pain, or tenderness in a peripheral joint or bursa, including the development of a tophus 3
- The condition is caused by monosodium urate crystal deposition in joints and tissues, with risk factors including male sex, obesity, hypertension, and diet rich in meat and seafood 3
Dietary Management
- Dietary recommendations for gouty patients generally focus on food categories, with few simultaneous considerations of nutritional factors and systemic metabolism 4
- A comprehensive review of the mechanistic findings and potential interventions of diet-related nutrients against the development of gout can help patients choose a healthy diet based on personal preference and disease course 4
- Dietary modification strategies for gout management include reducing nutritional risk factors against metabolic syndrome, supplementing with beneficial nutrients to affect uric acid metabolism and gouty inflammation, and considering nutritional modification combined with medication supplementation to decrease the frequency of gout flares 4
- A low-purine diet may not be the most effective approach, as it may lead to increased consumption of unhealthy carbohydrates and fats, contributing to metabolic syndrome and raising serum urate levels 5
- Healthy dietary patterns, such as the Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets, in combination with weight loss for those who are overweight or obese, have beneficial effects on relevant gout endpoints 5
Lifestyle Modifications
- Lifestyle modifications, including diet and weight loss, form a part of gout prevention 6
- Patients with gout are often recommended to follow a healthy lifestyle, including a balanced diet and regular exercise, to reduce the risk of flares and improve overall health 3
Pharmacotherapy
- Pharmacotherapy for gout includes urate-lowering therapy, such as allopurinol and febuxostat, as well as anti-inflammatory treatment of acute flares with NSAIDs, colchicine, and corticosteroids 3, 6, 7
- Novel therapies, including IL-1β antagonists and uricosurics, are also available for the treatment of gout 6
- The choice of pharmacotherapy depends on the individual patient's needs and medical history, and should be guided by a healthcare professional 3, 6, 7