What is Gout?
Gout is one of the most common forms of arthritis in the UK, and the most common cause of inflammatory joint disease 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 – but 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.
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. 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 as a result of overindulgence.
- 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.
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 gout 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.
Short-term pain management: The immediate priority will be to treat the pain 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.
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.
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No patient/doctor relationship is to be inferred and you should seek medical advice from a qualified practitioner.
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