How to recognise and manage gout
People with gout have higher rates of other conditions including highblood pressure, diabetes and heart problems.
Growing up, I remember my dad occasionally cracking jokes about his brother. He suffered from gout, and from time to time, in an act of defiance at having to take medication at all, he would wash his tablets down with red wine – ‘‘the very worst thing he could do‘‘, according to my father.
However it turns out that red wine probably wasn’t the worst thing he could have done, and in fact had he washed his medicine down with beer, or taken it after a large feed of scallops and mussels, things could have been a whole lot worse.
So here are some facts about gout, and some tips on how to manage it:
❚ Gout is a type of arthritis – this means it affects the joints in our body, typically feet, hands, knees and elbows. Gout can occur if you have high levels of a substance known as uric acid in your blood – in some people this uric acid will turn into sharp crystals that deposit themselves in the joints, causing pain and swelling. However, many people who have high uric acid levels will never develop gout so there are likely to be other factors at play as well, including our innate ability to produce and excrete uric acid from our body.
❚ Gout is more common in men – it is thought that about 1 per cent of us will be affected by gout at some point in our lives, but this figure is much higher for men, and also much higher for Pacific and Ma¯ ori people. It is a ‘‘chronic’’ condition which means that once you have it, you will always have it – but it won’t always be a problem: some people will only ever have one flare-up of gout in their lives, while others might suffer from several attacks a year.
❚ The symptoms of gout are quite typical: sudden onset of pain, redness and swelling in usually one, but sometimes several, joints. The pain typically develops over six-12 hours and can be excruciating – people with gout in their feet will often describe being unable to stand or walk in the first few days of an attack as the pain is so bad. If left untreated, symptoms will usually subside over 14 days then resolve completely. If symptoms persist beyond this time, it is possible that you don’t have gout but another type of arthritis, so it is worth speaking to your doctor and getting more tests done.
❚ Some people who have gout will develop large deposits of crystals that don’t go away, typically around the tendons of the hands, heel, and elbows and on the ears. These are known as tophi and are visible as hard, raised swellings beneath the skin. They can lead to deformity of the surrounding tissues and restricted movement.
❚ You should get tested if you think you might have symptoms to suggest gout, or if gout runs in your family. Your GP will first examine your joints to look for any suggestive signs and will then run some blood tests to look for high uric acid levels, as well as other measures of inflammation in your body. If the diagnosis is unclear, they may need to look at a sample of fluid from a swollen joint – if the lab can see the crystals typically associated with gout on your sample, that is a definite diagnosis of gout.
❚ Treatment of an acute attack of gout is quite simple – ice packs can help the pain, as can rest, especially if the joint affected is in the foot. Anti-inflammatory analgesia (such as naproxen, ibuprofen or diclofenac) is crucial, as long as you can safely take it and it doesn’t affect your stomach. If you can’t take antiinflammatories, or you still have symptoms despite that, your doctor might prescribe a medicine called colchicine that can reduce the severity and duration of your symptoms.
❚ Once your attack has settled down, it is important to look at your underlying risk factors. We think that around 80 per cent of the risk is probably innate or genetic – that is, the way your body is able to produce, metabolise and excrete uric acid. There isn’t much you can do to alter that, other than to be aware if it is in your family. But the other 20 per cent of the risk is modifiable and comes largely from diet – being overweight is strongly linked with having gout, so losing weight is a key part of preventing flare-ups. Trying to lower the amount of purines in your diet is also helpful – which is where the advice about alcohol comes in. Alcohol in large quantities isn’t a great idea with gout, but especially beer – and even beer in smaller amounts seems to be a trigger for some people. Other things that contain purine in high levels include offal (especially heart, liver and kidneys), seafood (especially mussels, scallops, crays, anchovies, sardines, mackerel and prawns) and red meat. Fizzy sugary drinks and fruit juices are also culprits when it comes to raising uric acid levels, so trying to cut down on them is also recommended. Some medications can also elevate your uric acid levels, so check with your doctor and make sure your aren’t taking something that could be making it worse.
❚ If you get more than two flare-ups in a year, talk to your doctor about going on some long-term medication to reduce your uric acid levels and minimise your risk of gout attacks. Options for longterm treatment include drugs like allopurinol, febuxostat and sulfinpyrazone. Your doctor will ensure you find the one that is most effective and suits you best.
❚ Lastly, ensure you get regular check-ups. People with gout have higher rates of other conditions, including high-blood pressure, diabetes and heart problems, so getting an annual review is a great idea.
For more information, visit Health Navigator healthnavigator.org.nz.
❚ Dr Cathy Stephenson is a GP and mother of three.