Gout is considered a form of arthritis, since sufferers primarily experience excruciating pain in the joints, most often the joints of the big toe and foot. The formation of gout is directly linked to an overabundance of uric acid in the bloodstream. As uric acid levels rise, crystals form and collect in the base joint of the sufferer's big toe. These crystals of uric acid are painful enough, especially when they become lodged deep in the joint. Adding to the misery of gout is a secondary skin inflammation, with increased sensitivity, redness and swelling.
Gout generally appears in the form of short attacks, sometimes lasting for several days or weeks. Much like those with kidney stones, gout sufferers can be symptom-free for several years between attacks. Uric acid crystals are also responsible for one form of kidney stones. Gout can become chronic over time, which means the sufferer must take daily medications in order to prevent the onset of major symptoms and extreme pain.
Gout is usually treated through dietary changes and nonsteroidal anti-inflammatory drugs (NSAIDs). During a gout attack, physicians may inject prescription NSAIDs directly into the affected joint, along with a drug designed specifically to reduce the size of uric acid crystals. The use of aspirin for pain relief from gout is strongly discouraged. An over-the-counter NSAID such as Ibuprofen may take the edge off the pain, but will not mask it completely.
At one time in history, gout was viewed as a disease of the wealthy, since the foods which triggered it were primarily available to richer citizens. Research has since shown that the main culprit for the formation of gout is an organic substance called purine. Foods with high levels of purine, including organ meats, beans and red meats, contribute to the body's level of uric acid.
Ordinarily, the body can metabolize uric acid and send the excess through the urinary tract for elimination. For some reason, people prone to gout cannot fully process purine-rich foods, leading to the formation of crystals and a full-blown attack. Dietary treatments for the prevention of gout include restrictions on purine-rich foods and the addition of dark red berries, blueberries and celery extracts.
Gout occurs when urate crystals accumulate in your joint, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood. Your body produces uric acid when it breaks down purines — substances that are found naturally in your body, as well as in certain foods, such as organ meats, anchovies, herring, asparagus and mushrooms.
Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes your body either produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needle-like urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.
The small joint at the base of the big toe is the most common site of an acute gout attack of arthritis. An acute attack of gouty arthritis at the base of the big toe is medically referred to as podagra. Other joints that are commonly affected include the ankles, knees, wrists, fingers, and elbows. Acute gout attacks are characterized by a rapid onset of pain in the affected joint followed by warmth, swelling, reddish discoloration, and marked tenderness. Tenderness can be intense so that even a blanket touching the skin over the affected joint can be unbearable. Patients can develop fever with the acute gout attacks. These painful attacks usually subside in hours to days, with or without medication. In rare instances, an attack can last for weeks. Most patients with gout will experience repeated attacks of arthritis over the years.
Uric acid crystals can deposit in tiny fluid-filled sacs (bursae) around the joints. These urate crystals can incite inflammation in the bursae, leading to pain and swelling around the joints (a condition called bursitis). In rare instances, gout leads to a more chronic type of joint inflammation that mimics rheumatoid arthritis.
In chronic (tophaceous) gout, nodular masses of uric acid crystals (tophi) deposit in different soft-tissue areas of the body. Even though they are most commonly found as hard nodules around the fingers, at the tips of the elbows, in the ears, and around the big toe, tophi nodules can appear anywhere in the body. They have been reported in unexpected areas such as in the vocal cords or (rarely) even around the spinal cord. When tophi appear in the tissues, the gout condition is felt to represent a substantial overload of uric acid within the body.
If you have gout, your treatment plan will have two goals:
to relieve the symptoms of a gout attack
to prevent further attacks from occurring
During a gout attack, it is important to rest, elevate (raise) your limb and avoid accidentally knocking or damaging the affected joint.
Keeping the affected joint cool should help improve your symptoms. To cool the joint, remove any clothing from around the joint and apply an ice pack. You can buy ice packs from a pharmacist, or you can use a bag of frozen peas or some ice wrapped inside a towel.
Apply the ice pack to your joint for approximately 20 minutes. Do not apply ice directly to your skin and do not apply it for more than 20 minutes at a time because this could damage the skin.
Non-steroidal anti-inflammatory drugs (NSAIDs) are a type of painkiller usually recommended as an initial treatment to relieve the symptoms of gout. NSAIDs work by reducing the levels of pain and inflammation. NSAIDs often used to treat the symptoms of gout include:
diclofenac
indometacin
naproxen
If you have been prescribed NSAIDs for gout, it is best to keep them near you at all times so that you can use them at the first sign of a gout attack. Continue to take your medication throughout the attack and for 48 hours after the attack has finished.
NSAIDs must be avoided in people with reduced kidney function and only used with great care under medical direction in patients who have had problems with indigestion, stomach ulcers or bleeding.
If you are unable or do not want to take NSAIDs, or if NSAIDs are ineffective at treating your symptoms, colchicine can be used instead. Colchicine works by interfering with the uric acid crystals to reduce inflammation.
While colchicine is usually an effective treatment for gout, it is no longer widely used because it can cause troublesome side effects, including:
nausea
vomiting
abdominal pain
Colchicine can be very poisonous if it is taken in too high a dose. It is very important to follow the recommended dosage schedule. For most people, this means taking two to four tablets a day.
Corticosteroids are a type of steroid. They are sometimes used to treat severe cases of gout that do not respond to the treatment above.
The relief provided by corticosteroids is often rapid, although these medicines can rarely be used in the long term. This is because long-term use can often cause.
Corticosteroids can also worsen diabetes and glaucoma (an eye disease that is caused by blocked fluid in the eye).
Do not take corticosterodis if you have:
bone marrow disease
impaired kidney function
impaired liver function
heart failure
Do not take corticosteorids if you are pregnant or breastfeeding.
There are two methods that can be used to try to prevent further attacks of gout. These are:
using medication to reduce your uric acid levels
making lifestyle changes to reduce your uric acid levels
If you experience two or more attacks of gout within a year, you will usually be prescribed a medication to help prevent further attacks. This will usually be a medication called allopurinol.
Allopurinol helps lower your uric acid levels by disrupting the enzyme responsible for converting purines into uric acid. However, allopurinol is not a painkiller and will have no effect during a gout attack.
If you are prescribed allopurinol, you will have to take it once a day. It usually has to be taken for two to three months before you see any effects. If you are prescribed allopurinol, you will usually have to take it indefinitely. However, you may only be able to stop taking the medicine if you have a normal serum uric acid level for many years and have no attacks of gout during this time.
When you start taking allopurinol, it can sometimes cause a gout attack. It is not well understood why this happens, but it is usually advisable to delay treatment with this medication for one to two weeks after an attack of gout has settled.
However, if you do develop a flare-up of gout while taking allopurinol, you should continue the medication while your doctor prescribes additional treatment to settle the attack.
A skin rash is the most common side effect of allopurinol, affecting around 1 in 10 people. In most cases, the skin rash is mild and soon goes away. However, in a small number of cases, a skin rash can be a sign of a more serious allergic reaction. If you develop a skin rash while taking allopurinol, stop taking the medication immediately and contact your GP as soon as possible for advice.
A small number of people also have symptoms of dizziness, loss of balance and drowsiness when they start taking allopurinol. Exercise caution when driving or operating heavy machinery until you are sure that you are not affected by these side effects.
Some foods are high in purines. Avoiding eating them can help reduce your risk of having a gout attack. You may want cut out the foods below altogether, or at least eat only a moderate amount:
meat, particularly kidney, liver, veal, turkey and venison
seafood, particularly anchovies, herring, mackerel, sardines, fish roe, mussels and scallops
certain types of vegetables, such as asparagus, kidney beans, lima beans, lentils and spinach
foods or supplements that contain yeast extract, such as Marmite and Quorn
If you are overweight, the levels of uric acid in your blood often rise. Losing weight will help reduce your uric acid levels significantly.
If you need to lose weight, it is important to follow a balanced, calorie-controlled diet. Do not crash diet. A high-protein, low-carbohydrate diet should be avoided because high-protein foods often contain high levels of purines.
Ensure that you get plenty of regular exercise. Not only will this reduce your urate levels and decrease your risk of developing gout, but it will also leave you feeling more energised and healthier.
If you have a gout attack, you need to keep the joint rested and elevated (raised). Avoid exercise that puts strain on the affected muscles or joints. Swimming is a good way to stay fit without putting pressure on your joints as the water supports your weight.
It is important to drink plenty of water. Aim to drink about 1.2 litres (six to eight glasses) a day, or more if you are exercising or when it is hot. Keeping yourself well hydrated will reduce the risk of crystals forming in your joints.
Some types of alcoholic drinks are associated with a greater risk of developing gout than others.
Beer and stout contain significant quantities of purines, these carry a greater risk for the development of gout.
A survey has shown that daily consumption of a small glass of wine is not associated with an increased risk of developing gout.
However, binge drinking of any kind of alcohol can bring on an attack in people who have previously suffered with gout.
Other medical conditions can increase your risk of developing gout. These include:
psoriasis
diabetes
high blood pressure (hypertension)
If you have one of these conditions, it is important to manage and treat it as fully as possible. If you manage a condition, such as psoriasis, effectively, it will help prevent gout from recurring.