Gout occurs when high levels of uric acid in the blood drive the formation of urate crystals in the joints. The sharp crystals trigger intense pain and inflammation in the affected joints. Gout often recurs in increasingly severe episodes, especially if left untreated. Dietary factors and medical conditions can aggravate gout, worsening an ongoing episode or triggering a new one.
Diet
Anything that raises the blood level of uric acid can trigger or worsen an attack of gout. During and between gout attacks, the Mayo Clinic recommends that patients drink plenty of fluids, minimize meat proteins, and favor low-fat dairy sources of protein like tofu and eggs to avoid aggravation of symptoms or recurrence. Foods that contain high levels of purines such as organ meat, anchovies or sardines, meat gravy or broth, and mushrooms increase the levels of uric acid, as does alcohol, says the Merck Manual.
Aging
Aging brings a host of factors that can aggravate gout. With age, people are more likely to suffer diabetes, high blood pressure, high cholesterol levels and arteriosclerosis. Left untreated, any of these factors can cause or aggravate gout. The medications to treat some of these conditions can also cause or aggravate gout. The Mayo Clinic points to use of low-dose aspirin, often recommended to prevent heart attacks, and thiazide diuretics to control blood pressure as culprits that aggravate gout.
Recurrences
The Mayo Clinic says that after the initial attack of gout, later recurrences tend to be more severe because they affect more joints and the pain lasts longer. Recurrences tend to occur at progressively shorter intervals, according to the Merck Manual. Patients who ignore their gout and do not seek treatment risk worsening pain and eventual permanent damage to the affected joints, causing deformity and limiting mobility.
Effects
In addition to joint damage, patients who do not treat gout risk the development of kidney stones, an extraordinarily painful condition of urate crystallization within the kidneys. Recurrent gout can also drive the formation of tophi, deposits of clumped urate crystals under the skin. Although usually painless, tophi can become inflamed or even burst through the skin, states the Merck Manual.
Treatments
Treatments for gout can minimize recurrences and protect against most of the complications. Drugs that help prevent future attacks range from over-the-counter pain relievers to corticosteroids. For patients suffering from frequent episodes, doctors might prescribe medications to aid the elimination of uric acid from the body, such as probenecid, or medications called xanthine oxidase inhibitors, such as febuxostat, to block the formation of uric acid.
Warning
The Mayo Clinic warns that taking a xanthine oxidase inhibitor while the effects of a gout attack linger can trigger the onset of a new acute episode. It recommends taking low doses of colchicine, which helps prevent new attacks, before starting a xanthine oxidase inhibitor to reduce the likelihood of a new episode.
