Family Health: Sudden, severe joint pain at night? It could be gout.

Gout is a type of arthritis that was once known as “the disease of kings.” If you have gout, though, that’s probably slim comfort. Your first symptom is likely to be sudden, intense pain in a big toe that wakes you up at night – hardly the royal treatment.

The pain comes from needle-like crystals that form in joints, usually in the feet, ankles, knees, hands or wrists. The affected joints can also become red, hot and swollen, and stay that way for a few days to several weeks. Gout symptoms usually resolve completely, but most people have another attack within a year or two. Over time, gout attacks get more frequent.

All this happens because of an excess of uric acid in the body. Uric acid is formed from the breakdown of substances called purines, which occur naturally in your body and also in certain foods. When your body produces too much uric acid or your kidneys can’t remove it well enough, the buildup can lead to painful urate crystals forming in your joints. Certain foods and drinks may also increase uric acid levels, which could be the reason for gout’s early association with kings – these foods, including shellfish, organ meats and alcohol, may have been considered royal fare.

The sudden, painful, nighttime attack of joint pain is good clue to a diagnosis of gout. But the symptoms can begin at any time and can occur in more than one joint. To confirm the diagnosis, your doctor may extract fluid from an affected joint and use a microscope to look for urate crystals. X-rays can help rule out other causes for your symptoms. And a test to show the level of uric acid in your blood is often done along with other tests, but that measurement alone isn’t definitive. High levels don’t always indicate gout and normal levels don’t rule it out.

Gout occurs more often in men than women, and it tends to run in families. People who take certain diuretic medications and those who use immunosuppressants after an organ transplant are at higher risk for gout. It’s also more likely in people who are obese, and those who have high blood pressure, high cholesterol and triglycerides, and diabetes. In fact, losing weight – which can reduce your risk for these conditions – is a good way to avoid or control gout.

People with gout need to eat carefully for other reasons, too. They need to avoid:

  • Certain types of seafood that are high in purines, such as anchovies, herring, sardines, scallops, mackerel and tuna.
  • Organ meats such as liver and kidneys, which are also high in purines.
  • Alcohol – especially beer – which may increase uric acid production in your body.
  • Drinks and foods that are high in fructose.

On the other hand, gout may be unaffected or even improved by:

  • Vegetables that are high in purines. Studies have shown that they don’t increase your risk of developing gout or having recurring attacks. Since fruits and vegetables are essential for a healthy diet, even people with gout can eat high-purine veggies like asparagus, spinach, peas, beans and lentils.
  • Coffee. Moderate consumption of coffee may reduce the risk of gout.
  • Vitamin C. A daily 500-miligram supplement of vitamin C may help lower uric acid levels.
  • Cherries. Some research shows that eating cherries or drinking cherry juice can lower your risk of gout attacks.
  • Drinking plenty of water.

Certain medicines can help minimize gout attacks by blocking uric acid production or lowering its levels in the blood. When gout does flare up, a medicine called colchicine can help relieve symptoms if taken early on. Nonsteroidal anti-inflammatory drugs, or NSAIDs, can also help. For some people, a corticosteroid such as prednisone is the best choice. And don’t forget the old standby – an ice pack on the painful joint.

About 3 million people in the U.S. have gout, and that number is rising. You can learn more about this condition by visiting the American Academy of Rheumatology at rheumatology.org. If you have symptoms of gout, see your doctor as soon as possible. Treatments work best if they are tailored for each individual, and the sooner you start the better.