Gout is a type of arthritis that causes sudden and extremely painful attacks in the joints of the foot, knee, ankle, hand and wrist – especially the big toe.
It is a common joint disease affecting one in 14 men, one in 3 women but is rare in children. In men, it can occur any time after puberty, whereas in women it is uncommon before the menopause. In around one in ten cases, there is a family history of the disorder. Men who are older, overweight, have high blood pressure, eat diets rich in shellfish and animal protein and drink large quantities of alcohol or sugar-sweetened soft drinks, have an increased risk of developing gout.
What causes Gout?
Gout is caused by excess uric acid in the bloodstream. All of the cells in the human body, and many of the foods we eat, contain substances known as purines. As old cells are broken down, or as foods are digested, these purines are converted to uric acid, which is carried in the blood as a salt called urate. Most people with gout have high levels of urate in their blood because they do not pass enough urate in their urine. It can also be caused by too high levels of uric acid in the diet, crash dieting, stress, prolonged illness, injury, or by some drugs e.g. aspirin or water tablets. An overload of uric acid in the body means that urate crystals start to form in and around the joints and also under the skin e.g. on the ear, as small white pimples (known as tophi) Occasionally, stones may form in the kidneys.
What are the symptoms of gout?
A sudden, unexpected (acute) attack of gout often develops during the night or early hours of the morning. It reaches a peak within a few hours. The skin may be red and shiny and the inflammation may be so severe that the skin may peel. A mild fever, loss of appetite and a feeling of tiredness can also accompany acute attacks of gout. An untreated attack generally lasts for a few days, then dies down and the joint gradually returns to normal. Some people never experience another attack. If the uric acid level remains high, most will have a second attack between six months and two years after the first. Untreated attacks will become more frequent and more prolonged and may result in damage to the cartilage and bone.
How will I know if it is gout?
Your doctor will be able to check whether you have gout by carrying out simple blood test to ascertain uric acid levels in your blood.
A more specific test is the analysis of the fluid in the affected joint. Fluid from the space between the joint is removed through a needle and syringe and then examined under a special type of microscope. The presence of needle-like, uric acid crystals confirms the diagnosis of gout. However, this approach may not be practical if the joint is a small one. Another important reason for doing medical tests is that gout patients have greater than average risks of having, or of developing medical problems such as diabetes and cardiovascular diseases, including heart attacks and strokes. Therefore when someone develops gout, this should be taken as an opportunity to consider other aspects of his or her health – such as blood pressure, obesity, cholesterol and sugar levels, all of which can be associated with increased risks of vascular disorders.
Attacks of gout are usually treated with anti-inflammatory medicine like ibuprofen.
If the gout doesn’t improve after 3 to 4 days, you might be given steroids as tablets or an injection. Gout can come back every few months or years. It can come back more often over time if not treated, however lifestyle changes can make a difference
- Aim for a healthy, balanced diet, with plenty of vegetables and some low-fat dairy foods. Avoid a lot of red meat, kidneys, liver, seafood or fatty foods
- Get to a healthy weight, but avoid crash diets – learn more about healthy weight loss here
- Exercise regularly – but avoid intense exercise or putting lots of pressure on joints
- Stop smoking
- Ask your GP about vitamin C supplements
- Have at least 2 alcohol-free days a week and do not drink more than 14 units of alcohol per week (particularly on the one day)
- Drink plenty of fluids to avoid getting dehydrated
If you have frequent attacks or tests show you have a high level of uric acid in your blood, your GP might prescribe medicine called allopurinol or febuxostat. This is used to lower the levels of uric acid and needs to be taken in the long term. It’s important to take uric-acid-lowering medicine regularly, even when you no longer have symptoms.
For further information on gout please see the link below
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