Gout
is a painful form of arthritis that can affect toe, foot, ankle, knee, hand and
elbow joints. Symptoms include pain, swelling and shiny redness over the
affected joints. Treatment of acute gout attacks is designed to
relieve pain and inflammation, primarily through medication. Diet and
other lifestyle changes can help prevent future attacks.
Gout
is a painful form of arthritis (inflammation of the joints). It is sometimes
referred to as gouty arthritis. The most common place for gout to develop
is the big toe; however the joints of the feet, ankles, knees, hands and elbows
can also be affected. It is unusual for gout to affect more than one or
two joints at a time.
The prevalence of the gout is 0.2% in developed countries. Gout most commonly affects
adult men and is uncommon in women until
after menopause, male to female ratio 10:1.
Gout is
caused by raised levels of uric acid in the blood (hyperuricaemia). Uric
acid is produced naturally in the body. Normally it stays dissolved in
the blood and is excreted by the kidneys as a component of urine.
Under-excretion or over-production of uric acid by the body can cause levels in the blood to be raised. When this occurs, crystals of uric acid can form and deposit in the joints causing gout. However, not all people with raised uric acid levels in their blood will develop gout.
Crystals deposition in gout
A number of
risk factors are related to the development of gout. These include:
- Obesity
- High alcohol intake
- A genetic predisposition
- High intake of foods rich in
purines (eg: some seafoods and some meat)
- Certain medicines eg: diuretics
(fluid tablets)
- Injury to a joint
- Long-standing kidney disease.
Occasionally
there is no obvious cause for an attack of gout.
Gout
develops over short period of time . Signs and symptoms of a gout attack
include:
- Severe pain and tenderness in
the affected joint
- Swelling of the affected joint
- The skin over the joint may
feel hot and tight and may look shiny and red.
Some people
may also experience nausea, a loss of appetite and a slight fever.
Gout
can be difficult to diagnose because the symptoms may mimic those of other
conditions such as joint infection. In order to make an accurate
diagnosis need to examine the affected joint and take a full medical history.
They will assess the nature and duration of the symptoms experienced. A
blood test to check for alterations in normal blood levels and a raised uric
acid level will also be taken. Results of this test may not always be
helpful, however, as they often indicate normal uric acid levels during an attack
of gout. This is likely to be because the excess uric acid has moved out
of the blood and has settled as crystals in the joints.
In
order to make a definitive diagnosis of gout the doctor may take a sample of
fluid from the affected joint. This is performed using a local anaesthetic and
involves inserting a needle inserted into the affected joint and removing a
small amount of fluid. The fluid is then sent to a laboratory where it is
tested for the presence of uric acid crystals. If they are present, then
gout is confirmed. X-rays of the affected area may also be taken to
check for joint damage.
Medical
treatment is aimed at relieving the pain and inflammation of acute attacks and
preventing the occurrence of future attacks.
Without treatment
it may take up to a week for symptoms of a gout attack to subside.
Attacks of gout can recur. At first the time period between attacks can be as
long as several months or even years. However over time attacks tend to
occur more frequently and tend to be more severe.
TREATMENT OF
ACUTE ATTACKS
ANTI-INFLAMMATORY
MEDICATIONS
Particularly non-steroidal anti-inflammatory medications
(NSAIDs) such as indomethacin, naprosyn or diclofenac. Taken early in the
attack NSAID's can reduce the duration and severity of the attack.
Paracetamol taken in conjunction
with other medications can help in reducing pain. Aspirin should be avoided as
it can reduce the amount of uric acid excreted by the body.
COLCHICINE
This medication helps to block production of uric acid. It
is most effective when taken early in an attack. However, it can have
side effects such as diarrhoea if too much is taken.
STEROIDS
Such as prednisone may be given in tablet form to help
reduce pain and inflammation. Steroid injections directly into the joint
may also be effective.
DRINKING EXTRA FLUID
Adequate amount of water while taking these
medications is recommended.
PREVENTING
OF FUTURE ATTACKS
Preventing attacks of gout is as important as treating the symptoms of an acute attack. Ways in which gout can be prevented include
MEDICATIONS
The mainstay drug for
people with gout is allopurinol which acts to reduce uric acid production.
People who cannot take allopurinol because of side effects will usually be
prescribed probenecid instead, which acts to increase the excretion of uric
acid by the kidneys. Other medicines that may be prescribed in certain
circumstances are benzbromarone and febuxostat. In the initial stages of
treatment with medications to prevent gout, attacks may occur more frequently
and may be more severe. For this reason the dosage of the medications may be
low to start with, and is then gradually increased.
DIETARY
MODIFICATIONS
Are
aimed at restricting or avoiding foods high in purines. Purines are
substances found in some foods and produce uric acid when broken down by the
body. Foods high in purines include
Foods
to be avoided in gout
- Shellfish
(pipis, paua, oysters, mussels) and fish roe
- Offal
foods (brains, liver, kidney, tripe)
- Red
meat (beef, pork/bacon, lamb)
- Yeast
extracts (Marmite, Vegemite)
- Foods
containing yeast (bread, beer)
- Oily
fish (sardines, herrings and anchovies).
LIMITING
ALCOHOL INTAKE
is also important. Alcohol causes the
body to lose fluid (by increasing urine output and drawing water from the
blood), thus increasing the uric acid concentrations in the blood. Beer
is rich in purines so should be avoided.
DRINKING
PLENTY OF NON-ALCOHOLIC FLUIDS
Eight to ten glasses a day is
recommended. This will help to flush the uric acid crystals out of the
body.
MAINTAINING
A HEALTHY BODY WEIGHT
Will help to reduce stress on affected joints
and decrease the likelihood of developing gout.
If
uric acid levels remain raised for long periods of time, or there are frequent,
recurrent attacks of gout, deposits of uric acid salts may appear around the
affected joint. These are called tophi and appear as chalky coloured nodules.
Tophi may also appear in other areas of the body such as the ears.
Recurrent severe attacks of gout and the development of tophi can
cause permanent damage to the joints. Surgery may be required to restore
joint function. This may involve joint replacement surgery.
Damage
to the delicate filters within the kidneys and the development of kidney stones
can also occur if uric acid levels in the blood remain raised for long periods
of time. This in turn can impair kidney function.
In
order to prevent the complications of gout it is important to treat gout
attacks quickly and prevent gout attacks recurring by adopting the measures
outlined above. It is also important to carefully follow the treatment
instructions given by a doctor.
