Gout

Gout is a form of arthritis caused by a build up of uric acid within the body which is a waste product of metabolism.

Symptoms

Symptoms tend to come on very quickly and then last for around a week before easing off. They include intense pain in the joint, usually affecting the big toe and foot. The skin may appear red and shiny and there may be peeling or flaking of the skin. The joint will be swollen and may also feel itchy. Gout is most common in the big toe, but may also be present in the heels, ankles, knees, elbows, wrists or fingers.

Explained

Gout is more common in men although it does occur in women as well. It is most prevalent in men between the ages of 40 and 60. You are more likely to suffer with gout if anyone in your family does as there is a genetic element involved. Risk factors also include a diet high in some meats, seafoods and alcohol, particularly beer.

Certain medications such as aspirin, niacin, diuretics and chemotherapy may also contribute to the development of gout. It is therefore more common in those who suffer from high blood pressure, high cholesterol and cancers as well as diabetes and psoriasis. Problems with the function of the kidneys, or high production of uric acid may mean that crystals develop within the joints which cause pain and inflammation.

Diagnosis

The symptoms recorded by your G.P are often used to give a clinical impression that gout is causing the pain. However, to properly diagnose the condition further tests are required:

Serum Uric Acid Tests are performed on a small sample of blood, usually taken from the arm. The test is often carried out 4-6 weeks after an attack because the serum uric acid level is often not elevated at the time symptoms are worst. A raised serum uric acid test result is an indicator that you may have gout, although this is not 100% accurate as people without the condition may sometimes have a higher than normal levels.

Synovial Fluid is found within synovial joints and a sample can be extracted from a joint and examined under microscope. In those with gout, there will almost always be crystals of sodium urate in the sample. This kind of test can also rule out other causes of joint pain.

Treatment

Symptom relief

Gout is managed by relieving the pain and treating the condition with both medication and lifestyle changes. To relieve symptoms, rest with the foot elevated and apply cold therapy to cool the joint.

Non-steroidal Anti-inflammatory drugs (NSAID's) such as Ibuprofen can be taken in the first instance to decrease pain. If these are not effective, then your doctor may prescribe Colchicine, which helps to relieve pain and reduce swelling. It does however often produce side effects such as nausea, vomiting and abdominal pain. In extreme cases, you may be prescribed corticosteroids, although these are not a long-term treatment.

Medications

Medications for frequent attacks are known as Urate Lowering Therapies or ULT's. The aim of these medications is to reduce the urate levels to below the concetration required for crystals to form. They also help to dissolve existing crystals.

There are different forms of ULT which have different effects and side-effects. Allopurinol is one of the most common. Febuxostat is another.

Lifestyle changes

Lifestyle changes should also be implemented to avoid flare ups of the condition. Eliminating or at least cutting down on the following may be helpful:

  • Meats including liver, kidney, turkey, veal and venison
  • Seafood such as anchovies, mackeral, sardines, herrings, mussels and scallops
  • Vegetables including spinach, asparagus, and lentils
  • Anything containing yeast extract such as marmite
  • Alcohol - particularly beers and port

Ensure you also drink plenty of water. If you are overweight, loosing weight can help to decrease your uric acid levels, as can exercise.

For more information, please visit the Gout and Uric Acid Education Society.