Tip Sheets

Painful big toes: Just the beginning in covering gout

Eileen Beal
Eileen Beal

by Eileen Beal, M.A.

Gout, as recently updated guidelines explain, is “due to an excess body burden of uric acid.”

In most cases, the burden – a medical condition called hyperuricemia – is caused by over production of and/or poor metabolization of compounds called purines (see below). As the excess uric acid builds up in the bloodstream, it can form urate crystals that lodge in leg and arm joints (and the tendons, muscles and tissues surrounding them) causing gout, an inflammatory, excruciatingly painful, and sometimes disfiguring and disabling form of arthritis.

Risk factors for gout

Gout’s major risk factors include:

  • a diet rich in purines – naturally occurring and food-based compounds that break down into the uric acid

  • ethnicity/heredity

  • co-morbidities, such as hypertension, obesity, metabolic syndrome, type 2 diabetes, and chronic kidney disease, that help promote hyperuricemia

But there are other risk factors, too, including lead poisoning and medications used to treat many of the above-cited conditions.

As with other diet-related conditions, prevalence of gout has shot up in the US, and today over 8 million Americans are somewhere along the first-attact-to-chronic-gout continuum. It tends to manifest between the ages of 40 and 60 and affects far more men than women (who don’t tend to get it till after menopause) and those who have undergone organ transplants.

The gout-aging nexus

And, since it manifests with age and increased co-morbidities (see above) and Americans are aging with more co-morbidities and (as noted above) the American College of Rheumatology recently updated its gout guidelines (links to both parts below), you are going to be covering it.

The following are story ideas to get your journalistic juices flowing:

  • Advice on what to do after the first attack. What to eat and do to avoid triggering another attack.

  • The challenges – and rewards – of gout self-management. This recent CDC summary can help you put them in perspective.

  • Strategies for keeping gout – which has definite genetic and lifestyle links – at bay. This info will get you thinking.

  • Gout medications: Old standbys, new options, and what’s in the pipeline. Recently published guidelines here and here will give you an excellent grounding in both treatments and medications.

  • Alternative treatments: What works, what doesn’t. Articles from Science Daily, Dr. John Briffa, and Discovery Health will get you started.

  • A fun (and educational) Q-A on gout from NIAMS.

  • The future of gout research. A perusal of these journals will get you headed in the right direction.

  • The gout-kidney (and heart) connection and importance of managing all three conditions simultaneously.

  • The gout, diet, and the insulin resistance nexus.

Who ya gonna call

If you live in a city with an academic medical center (i.e. a hospital and/or hospital system affiliated with a medical school) contact the press folks handling rheumatology. For coverage with a national footprint, contact the press office at hospitals/centers with strong rheumatology. According to the most recent US News and World Report’s Top Hospitals list, the best of the best are: Johns Hopkins, Cleveland Clinic, and Mayo Clinic.

Or contact the following:

American College of Rheumatology
Bonney Senkbeil, Media Relations
Office: 404-633-3777
Email: bsenkbeil@rhematology.org

Herbert Baraf, M.D., rheumatologist  
Arthritis & Rheumatism Association    
Office: 301-942-7600
Email: hsbbaraf@mac.com 

Joan M. Bathon, M.D., director of the Division of Rheumatology at New York- Presbyterian Hospital/Columbia University Medical Center and Professor of Medicine at Columbia University College of Physicians and Surgeons
Office: 212- 305-4308
Email: jmb2311@columbia.edu

Scott Berg, D.O., F.A.C.R., Department of Rheumatologic and Immunologic Disease, Cleveland Clinic
Laura Ambro, Media Relations
Office: 216-636-5876
Email: ambrol@ccf.org

Kenneth G. Saag, M.D., M.Sc., director, Center for Education and Research on Therapeutics of Musculoskelatal Disorders, Division of Clinical Immunology and Rheumatology, University of Alabama/Birmingham
Office: 205-996-9784
Email: ksaag@uab.edu

Raymond Pertusi, D.O., rheumatologist, UMass Memorial Medical Center
Office: 508-334-5224
Email: rmfp@aol.com  

H. Ralph Schumacher, M.D., professor of medicine, University of Pennsylvania Medical School and Director of the VA Medical Center’s Arthritis Clinic
Office: 215-823-5979
Email: schumacr@mail.med.upenn.edu

National Institute of Arthritis and Musculoskeletal and Skin Diseases
Patricia Reynolds, Media Relations
Office: 301-496-8190
Email: patricia.reynolds@nih.gov

Background/Basics

2012 American College of Rheumatology Guidelines for Management of Gout Part I: Systematic Non-pharmacologic and Pharmacologic Therapeutic Approaches to Hyperuricemia

2012 American College of Rheumatology Guidelines for Management of Gout Part II: Therapy and Anti-inflammatory Prophylaxis of Acute Gouty Arthritis”

The Arthritis Foundation/Gout

National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse

MayoClinic.com Gout Information

UpToDate Patient Information: Gout