What is Gout?
Gout is a common and complex form of arthritis that can affect anyone. It is characterised by sudden attacks of intense pain often coupled with swelling of the affected area.
It is a common condition affecting between 1 in 2 in every 100 people in the UK. Gout usually affects males over 30 and women post-menopause however, it is more common in men than in women.
What causes Gout?
Gout occurs when small crystals that are a waste product of Uric Acid, build up in the body and accumulate in the joints. This causes inflammation and intense pain that is assocuated with a gout attack. Uric Acid is formed naturally in your body when it breaks down purines.
If the body begins to produce too much uric acid, the excess will build-up, ultimately turning into microscoptic crystals which form in and around the body's joints.
What are the symptoms of Gout?
Gout can affect in any of the body's joints, though it commonly affects the toes, ankles, fingers, wrists, elbows and knees. The signs and symptoms of gout almost always occur suddenly, and often at night. They include:
- Intense Joint Pain: This usually occrs in the large joint of your big toe but can also occur in any joint. The pain is most severe within the first 4 - 12 hours.
- Swelling: The area of the joint directly affected will be swollen and also tender, warm and red.
- Limited range of motion: As gout progresses, you may not be able to move your joints normally.
- Lingering discomfort: When the most severe pain passes, some discomfort in the joint may remain from a peiod fo a few days to a few weeks. Any subsequent attacts are likely to last longer and affect more joints.
On average, an epispode of gout can last from three to 10 days, with our without medication. Some people may only have one attack in their lifetime, but without treatment or drastic change in diet and other risk factors, attacks may occur more frequently.
How is Gout diagnosed?
We recommend that you visit your GP if you suspect gout without previously being diagnosed. This is more so important when your symptoms are accompanied by a temperature of over 38 degrees celsius. In the majority of cases, your GP or doctor will be able to diagnose gout based on the symptoms presented. However they will also take into account your past medical history and examine the joint.
Certain diets can precipitate gout and they include:
- Red Meat
- Organ or Glandular meat such as liver, lidneys and sweetbreads
- Certain Seafoods; anchovies, herrings, sardines, mussels, scallops, trout, haddock, tuna and mackarel
Testing for Gout is carried out to both confirm the diagnosis and rule out other potential causes. These include:
- Blood Tests: these measure the amount of uric acid in the blood.
- Ultrasound Scan: this method detects crystals in the joints.
- X-Ray: whilst gout is rarely detectable on an X-Ray, a scan can help assess any damage caused by gout. Additionally, X-Rays can help rule out any similiar joint conditions such as chondrocalcinosis, which is an accumulation of calcium crystals in the joint.
How can I treat Gout?
Treatment for gout includes medicines that will help manage the pain of an attack and medicines that will help prevent future attacks.
The NHS recommends the following advice to effectively treat gout:
- Take medicine as soon as possible and it should work within 3 days
- Rest and raise the limb
- Keep the joint cool; using an ice pack or a bag of frozen peas qrapped in a towel for up to 20 minutes at a time
- Drink lots of water
- Try keep bedclothes off the affected joint at night
- Do not put pressure or knock the joint
The first line of treatment is an NSAID:
These are non-steroidal anti-inflammatory drugs (NSAIDs). This group of painkillers will help manage the pain and reduce any inflammation. Examples of NSAIDs used in treatment of gout include:
The above medicines are often prescribed alongside proton-pump inhibitors (PPIs) because NSAIDS can increase the risk of indigestion and stomach irritation, which the PPI will help to counter. NSAIDs should be taken immediately at the onset of an attack, and for 48 hours afterwards.
Another treatment that can be used is Colchicine:
If NSAIDs are unsuitable or not proven effective, then a medicine called Colchicine can be used. This will reduce the sweilling and releive the pain during a gout attack. When taken in high doses, colchicine can produce unpleasant side effects such as nausea, stomach pain, and diarrhoea.
How can I prevent Gout?
Preventing gout can be done in several ways, including lifestyle changes and preventative medicines.
Urate-loweeing therapy uses medicines, such as allopurinol, to lower the levels of uric acid in the blood. This is recommended for those who suffer from recurrent attacks, and for individuals who experience complications such as kidney stones or joint damage.
Lifestyle changes can also reduce risk of gout and they include:
- Get to a healthy weight
- Have a balanced and healthy diet with plenty of vegetables and low-fat dairy foods
- Avoid alcohol for at least 2 days per week (and less than 14 units per week)
- Exercise regularly
- Stop smoking