James Gilray's depiction of gout featuring a clawed devil attacking a human foot

Gout is a type of arthritis where swelling and severe pain develops in joints, especially at the base of the big toe. The condition affects approximately 1 in 40 adults. It is most common among men between 30-60 years of age.

Gout less commonly affects women. It is one of a few types of arthritis where future damage to joints can be avoided by having treatment. 

What causes gout?

Our bodies have a breakdown product called urate (or uric acid). Most urate is produced by the body. It breaks down substances known as purines and it usually passes out in our urine. If urate does not pass out of the body, or if you produce too much, it can build up and form crystals. 

 

George Cruickhank's humorous cartoon depicting the causes of gout featuring devil and a self indulgent man sitting at dinner table

Gout is caused when these crystals build up and form around the body's joints, causing inflammation and pain. Purines are found naturally in the body and in some foods, such as shellfish, red meat, and certain alcohols, such as beer. Drinking a lot of alcohol can also cause dehydration, which makes gout more likely to occur. Urate builds up either because too much urate is being produced by the body or because not enough is being passed out in urine (which may indicate kidney disease).

Some other diseases can also increase your likelihood of developing gout. These include heart disease, psoriasis and the treatment of some blood disorders such as leukaemia.

Not everyone with high urate levels will develop gout. We don't know why some people develop it. But if you are overweight you are more likely to develop it. A balanced diet and weight loss will reduce your chances of developing the condition. 

What triggers a gout attack?

The following are risk factors for gout:

  • if you are very stressed or have been ill

  • if you injure or bruise a joint. If you are prone to gout, and you have more pain in a joint than you would expect after a minor bump, it could be an attack coming on, so you need to get treatment straight away

  • taking diuretics (water tablets) or low-dose aspirin. Some people take these for high blood pressure or to prevent heart disease

  • dehydration

How does gout affect people?

Gout usually affects the big toes. It can affect other joints such as ankles, knees, hands, wrists or elbows, particularly people who get gout when they are older. The symptoms of gout can see joints start to ache, then swell up and become red, hot and extremely painful. The pain and inflammation caused by gout flare up can be extreme and should not be underestimated. 

The joint will be stiff. The joint may look as if it has a boil on it, or the skin can become shiny and peeling. You might also get a temperature and feel tired. An attack of gout can last from 1-10 days, then calm down, doing no permanent damage to the joint. It may be years before you have another attack. 

However, if you frequently experience gout flare ups, which is rare, you can develop more permanent arthritis in the joint, this can damage the joint and is known as 'chronic gout'. Chronic gout can also cause tiny white lumps to appear under your skin, especially on your ears, fingers or elbows. This is where urate crystals form under the skin, and they can be painful. If your urate levels are especially high, it can build up in the kidneys as stones, so you will need treatment to reduce the levels. 

How is gout treated?

People with gout are directed by the NHS to follow certain protocols which will help relieve the pain in conjunction with medication.

  • After consulting your GP medication should be started immediately as it can take 48 hours to begin to work.
  • The part of the body affected by gout should be kept raised and rested as much as possible like how you treat a bad sprain.
  • The joint should be kept cool as much as possible ice packs wrapped in towels are perfect, aim for 20-minute cooling sessions to help relieve pressure
  • Keep well hydrated unless directed otherwise by GP.
  • Do not put pressure on the affected joint.

Non-steroidal anti-inflammatory drugs (NSAIDs)

Very bad attacks of gout are usually treated with NSAIDs. These help reduce inflammation and so cut down the pain. You must always take NSAIDs with or straight after food to prevent stomach problems. NSAIDs can be taken at the first sign of an attack.

Cortisone type drugs

Corticosteroids might be given to you as tablets or an injection, if an acute attack does not respond to other drugs.

Self-help for gout

An ice-pack or pack of frozen peas, wrapped in a cloth, can be put on the sore joint for 30 minutes, several times a day, to bring relief and reduce inflammation. A frame over your foot to keep bedclothes off it can relieve pain at night.

If you are overweight, losing weight very gradually can help reduce the amount of urate in your blood. Do not go on a starvation diet. That can make gout worse.

Moderate exercise is important to keep joints moving. A physiotherapist can give you exercises geared to your needs.

Reduce the amount of alcohol you drink because dehydration can trigger gout. Alcohol, especially beer, can make it more likely for an attack of gout to occur. Drink lots of water - six to eight glasses a day - to help prevent kidney stones. This can stop urate forming into crystals.

For the best advice on how much water you should drink, talk to your doctor. It is helpful to cut down on foods which contain purines. The foods with the highest amounts of purines are liver, oily fish (herring, mackerel, sardines, fish roe, anchovies), beer, yeast and yeast extracts (like Marmite).

Who offers treatment for gout?

If you think you have gout or any kind of arthritis, see your GP. An infected joint can look the same as gout, so the doctor will need to rule that out. They might do a blood test to measure the amount of urate in your blood. They might also take some of the fluid from around a joint and get it tested to see if it contains any crystals. It is important to talk to your doctor not only about how to treat an acute attack of gout but also how to prevent another attack and manage the condition.

If your gout is severe and keeps flaring up, your doctor may suggest you see a rheumatologist - a specialist or consultant based at a hospital. They may be able to advise on taking stronger drugs like corticosteroids.

Credits

Header Image James Gillray, Public domain, via Wikimedia Commons

George Cruickshank Gout - Wellcome Collection (CC BY 4.0)

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1 comment

Gus Sire

Just know, that the absolute worst food is cocoa. The darker the chocolate, the worse.

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