What is Gout?
Gout is one of the most common forms of arthritis or inflammation of a joint. It most commonly affects the big toe joint (first metatarsophalangeal joint), but can affect any joint. Gout usually starts as an acute attack that often comes on overnight. Within 12 - 24 hours, there is usually severe pain and swelling in the joint.
Gout usually only affects one joint at a time (sometimes two) and most often the feet and ankles. The joint at the base of the big toe is the most common site. If there is no treatment, the gout attack usually subsides in a week or so. After the first attack there may be intervals of many months or even years
before there are other attacks. Over time, these attacks tend to become more frequent and more severe and eventually may involve other joints. Eventually, without treatment, a state of chronic or continuous joint symptoms may develop with progressive joint damage.
Gout mostly affects men and is very rare in women until after menopause when it is seen quite often.
Gout is very painful. The joint becomes swollen and the skin over the joint can be shiny or glossy in appearance.
The cause of gout is related to the physiology of uric acid, which is a chemical that is a natural part of the normal breaking down and building up of food and body tissues. When uric acid levels are higher, this is known as hyperuricaemia. Uric acid is normally dissolved in the blood, but when it's high, microscopic crystals may be deposited in the joint. These crystals then set up the acute inflammation, causing the gout.
As a result of this physiology, gout is common in those with hyperuricaemia. There are many causes of this and include:
- Some people just have higher levels and it is hereditary
- High alcohol intake
- High intake of food that contains purines (purines are broken down into uric acid) Some of the drugs used to treat high blood pressure can precipitate a gout attack Those with kidney disease may also develop high levels of uric acid
The mainstay of gout treatment is correcting the factors that lead to the high levels of uric acid. This involves a combination of diet and drugs.
The following foods have higher levels of purines and should be restricted or avoided:
Offal foods like liver, kidneys, tripe, sweet breads and tongue Large amounts of red meat
Peas, lentils and beans
Alcohol intake should be reduced
Being overweight is a risk factor, so weight loss may be very important. High blood pressure (hypertension) is also a risk factor that your doctor may need to address.
When an acute attack of gout occurs, anti-inflammatory drugs (NSAID's) are usually very effective to help gain control of the gout symptoms in the first 12 - 24 hours (these drugs have no effect at lowering uric acid levels). Rest and elevation of the foot is also important.
Over the longer term, if diet changes are not lowering the uric acid levels, drugs can be used to lower the levels (these drugs have no effect during an acute attack). The drugs must be taken on a continuous and long term basis if they are to be effective. There are basically two kinds of drugs - one increases the elimination of uric acid by the kidneys and the others block the formation of uric acid.
There are a number of things that you can do to help yourself manage gout:
Take your medication as instructed by your doctor Reduce weight
Take dietary advice to lower your intake of purines
If the uric acid levels have been high for a long time and acute attacks of gout have been frequent, there may be deposits of uric acid around the affected joint (and even elsewhere such as the ears). These are called tophi. If they present, there is an even greater need for long term drug treatment to lower the uric acid levels.