Dr Sarah Jarvis
My Weekly’s favourite GP from TV and radio writes for you
Gout is a kind of arthritis (-itis is the medical term for inflammation), but it’s very different from the more common osteoarthritis or rheumatoid arthritis. It causes short-lived attacks of severe pain and tends to affect only one or a few joints.
Gout is caused by a build-up of a chemical called uric acid. Normally, our bodies get rid of uric acid through our kidneys but some people don’t remove it very efficiently, and lifestyle factors can lead to it building up. With too much uric acid in the blood, excess gets deposited as tiny crystals in your joints. This results in irritation that leads to redness, swelling and pain, with tenderness so severe some people can’t even wear socks.
The joint at the base of the big toe is most commonly affected, although it can affect other joints and occasionally leads to hard deposits under your skin. Most attacks settle on their own within a week or two. Some people only ever get one attack in a lifetime, but more commonly people get occasional bouts.
For acute attacks of gout, the standard treatment is anti-inflammatory tablets. Drugs in this group, like diclofenac and indomethacin, aren’t used much anymore, because of the risks of heart attack in the long term. But if alternatives like naproxen don’t work, your doctor may recommend them for a few days. They should relieve symptoms within hours. You’ll need to treat them with caution as high doses for long periods can cause inflammation of or bleeding from your stomach. Your doctor may recommend taking a “stomach protector” medicine while taking them.
CHERRIES ARE DELICIOUS AND HEALTHY – AND IF YOU’RE A GOUT SUFFERER, EATING THEM REGULARLY CAN HELP KEEP ATTACKS AT BAY
If you get 2 or more attacks a year, your doctor may recommend regular medicine to cut the risk of further misery. The most common is allopurinol – the dose varies from 100mg to 300mg a day, and works by reducing uric acid in your blood. Your doctor will do blood tests to monitor uric acid levels. You shouldn’t start it until 4 weeks after any attack of gout settles, as it may make matters worse in the short term. If allopurinol doesn’t work there are alternatives.
Men get gout more than women, and it often starts in middle age. It can run in families, but your diet and weight can also play a part. Being overweight increases your risk, as do diabetes, kidney problems, high cholesterol, heart disease and high blood pressure.
Changing your diet can cut your risk of future attacks of gout significantly. To avoid gout you need to avoid foods containing a natural chemical called purine, which is broken down into uric acid:
Limit intake of red meat and poultry. Where possible, avoid sardines, herring, mackerel, trout, whitebait, anchovies, prawns, crab, liver, kidneys, stock cubes and marmite – all high in purine.
To keep your protein intake up without increasing your purine intake, try more low fat dairy products, eggs, tofu, nuts, beans and pulses.
Keep alcohol intake down. Beer is an issue for gout sufferers, but spirits and wine increase risk too. Keep fluid intake up to avoid dehydration (which can bring on gout), but avoid sugary drinks and any food or drink containing “high fructose corn syrup”.
Eat plenty of fruit and veg. Some research has suggested that lots of vitamin C can protect against gout. If you’re overweight, see your nurse or GP about a steady weight loss regime. Losing weight will cut your risk of gout, but high protein diets can increase uric acid levels. Next week: Is your thyroid healthy?
SOME MEDICINES USED TO TREAT HIGH BLOOD PRESSURE (AMONG OTHERS) CAN TRIGGER GOUT – SPEAK TO YOUR PHARMACIST