This month’s health column is about a common condition many people have heard of – gout.
We will cover what causes gout, what the symptoms are and how to treat it. Many people are aware of gout because they have a family member that has suffered with it – sometimes it is a condition that runs in families. Gout tends to affect more men than women and it is more common in older people, overweight people and those who drink a lot of alcohol. Some medications for high blood pressure called diuretics (water tablets) can also cause gout.
Gout is caused by having too much of a chemical substance called uric acid within the body. If your levels of uric acid are higher than normal, crystals can form around the joints which causes swelling. Affected joints often look red and shiny and can be very painful. One of the most common joints affected by gout is the joint at the base of the big toe, although it can happen in any joint (ankle, knee, elbow, shoulder, fingers). An attack of gout can happen quickly. Wearing shoes and walking may be a struggle if it affects the feet.
So how is it diagnosed? Often by hearing what has happened and examining the affected joint, a doctor or a nurse will be able to recognise gout. Blood tests for urate (uric acid) levels in the body can confirm the diagnosis. Often these blood tests are best taken after the acute episode of gout as if taken too early they might be falsely low. Sometimes if the diagnosis if not clear, further tests such as ultrasound scans and tests of the joint fluid (removed with a small needle) may be required.
Treatment for gout can be started without any tests. Normally it can help quickly to settle the pain. There are several different treatments available and it may depend on your medical history, and if you have had an attack of gout before, what is recommended. Anti-inflammatory medications are often used. In an acute attack of gout it is important to start medication quickly, rest the affected joint (keep it cool and elevated) and drink plenty of water to stay hydrated.
If you suffer from gout, there are several lifestyle changes you can make to stop it coming back. You should:
- Eat a healthy, balanced diet
- Reduce intake of red meat, liver and seafood
- Lose weight if you are overweight
- Reduce alcohol intake and have at least two alcohol free days per week
- Stop smoking
- Ensure you drink enough fluids to avoid getting dehydrated
- Exercise regularly – especially low intensity activities eg swimming, which are good for painful joints.
If you have recurrent episodes of gout and a high urate level, it is important to consider taking preventative therapy. There are medications called allopurinol and febuxostat and they work to reduce uric acid levels in the body. Having high levels of uric acid causes gout initially but, over time, it can also lead to small white lumps forming around affected joints (called tophi), kidney stones and chronic kidney disease (renal failure). Treating high levels of uric acid is important to avoid this irreversible damage to the joints and the kidneys. If you are put on preventative treatment for gout then blood tests will be taken to ensure it is working, that the dose is right and to monitor your kidney function. If you think you have gout, please see your GP promptly for assessment and to get started on treatment.