The very word gout can strike fear into anyone that has ever had even a passing association with the condition. But what is gout, what are the causes of gout and how do you treat gout?
People wish their enemies dead - but I do not; I say give them the gout, give them the stone! -Mary Wortley Mantagu
Such is the legacy of gout. Often referred to as the affliction of the rich, however, sadly not it’s only victim! Gout can strike virtually anyone at any time. Here we examine what it is, what causes it and what we can do to treat the painful condition.
What is Gout?
The condition is one of the most common forms of arthritis in the UK, and the most common in men over 40. Men can have an attack of gout any time after puberty but for women it's very rare to get gout before the menopause.
Typically, only a single joint is affected and most frequently this is the big toe. However, it can strike in the other toes, in the knee, the foot, ankle, wrist and in the fingers. In cases of chronic gout, performing everyday tasks, especially using your fingers, can be extremely difficult.
Gout is a very painful form of arthritis and can be extremely debilitating. Tiny needle-shaped crystals of uric acid (a biological waste product) accumulate in the joints, causing intense pain. Attacks tend to be sudden and severe, and typically last from 3 to 10 days. There are several likely causes of gout, but your family history, your diet, and being overweight are all factors.
Treatment focuses both on immediate pain relief, reducing the joint inflammation, and on bringing down the levels of uric acid in the blood to prevent future attacks. During an attack of gout, the slightest pressure on the affected area - even from a bedsheet - can be unbearable.
What are the causes of gout?
If you have high levels of uric acid in your blood there is a risk that microscopic crystals will start to build up in or around your joints, leading to gout.
Uric acid is a waste product formed when the body breaks down chemicals called purines which are in the body's cells. Your body might simply be producing too much uric acid, or your kidneys might not be flushing enough of it out of your system. This might be just an inherent weakness in your kidneys or because you have an underlying medical condition which prevents them from functioning normally, such as high blood pressure, high cholesterol or type 2 diabetes.
Since certain foods are rich in purines, your diet might also be a risk factor. Red meat (especially offal - liver or kidneys, for example), seafood and certain pulses are all rich in purines. So too are beer, fortified wines and spirits. Left unchecked it is not uncommon for the condition to result in kidney stones. Moderate consumption of wine is not thought to be a risk factor for gout.
Some medications can also prevent your kidneys from functioning fully and thereby increase your risk of gout - for example, medication for high blood pressure or high cholesterol. Your GP will discuss this with you before making any prescription.
A common myth about gout is that it occurs purely because of overindulgence.
The UK Gout Society have a useful online 'gout risk’ app which is worth trying if you have any concerns.
What are the symptoms of gout?
- Severe pain in one or more joints
- The joint is hot and tender
- Red shiny skin on the affected joint
- You might also have a fever and feel very tired
- In some cases, white crystal deposits (tophi) are visible under the skin
Attacks most frequently occur at night or in the early hours and can last up to 10 days. After that, your joint or joints will return to normal.
Most people who experience an attack of gout will do so again within a year. It's important to treat the underlying cause of your gout as otherwise attacks will be more frequent and could affect other joints, eventually causing irreversible damage.
However, in many cases gout can be treated successfully and further attacks prevented. If left untreated over the long-term, gout can cause irreversible damage to your joints.
How is gout diagnosed?
Your GP will examine the affected joint or joints, and ask questions about your family history, your diet and alcohol consumption. The simplest way to diagnose the condition is by taking a small sample of fluid from the joint in question and testing it to see if uric acid crystals are present.
An ultrasound scan is useful in detecting the presence of uric acid crystals in the joints which are not visible during a physical examination.
You might also be asked to have a blood test a couple of weeks after the attack has finished to ascertain if your levels of uric acid are unusually high.
How is gout treated?
Short-term pain management: The immediate priority will be to treat the pain and swelling by reducing the inflammation and you might be prescribed a traditional painkiller like ibuprofen.
Your GP might decide to prescribe a stronger type of painkiller - a non-steroidal anti-inflammatory drug (NSAID). These drugs work by reducing inflammation, and their prescription depends on an individual's reaction to the medication. Some people might also be prescribed a course of corticosteroids. Start taking your pain medication as soon as you have an attack and continue for 48 hours after the attack has ended to reduce the risk of reoccurrence.
You will also need to rest the joint - raising the limb when practicable. Drink plenty of water and keep the joint cool if possible - use ice packs or cooling pads.
You might also be advised to lose weight, and if so it's important to do this gradually, avoiding crash diets or fasting which are thought to be possible triggers for gout attacks.
Inconclusion, it is best to act quickly upon the first signs of this condition to shorten the painful flare ups. If you find you are susceptible to regular flare ups, then it is wise to take dietary and exercise measure to prevent.
The condition if left untreated can cause permanent damage to your joints.
Any information of a medical nature on this website is given to provide a general understanding of a medical condition or conditions. No patient/doctor relationship is to be inferred and you should seek medical advice from a qualified practitioner. Nothing on this site should be used as a substitute for competent advice from a qualified medical practitioner.