➤ Dr Dulcy: why do people get gout?
HIGH RISK: A FORM OF ARTHRITIS
It’s characterised by sudden, severe attacks of pain, swelling and redness in the joints.
Gout is a type of arthritis that can affect anyone. The usual symptoms are sudden, burning pain, and stiffness and swelling in a joint, usually a big toe.
These attacks can happen over and over unless gout is treated. Over time, these attacks can lead to damage to your joints, tendons, and other tissues. Men are more likely to get gout, but women become increasingly susceptible to gout after menopause.
Signs and symptoms
The signs and symptoms of gout almost always occur suddenly, often at night and without warning. They include:
Severe joint pain. Gout usually affects the large joint of your big toe, but it can occur in your feet, ankles, knees, hands and wrists.
Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks.
Inflammation and redness. The affected joints become swollen, tender, warm and red.
Limited range of motion. Decreased joint mobility may occur.
Causes
With gout, uric acid crystals accumulate in your joint, causing the inflammation and intense pain of a gout attack. Uric acid crystals form when you have high levels of uric acid in your blood.
Your body produces uric acid when it breaks down purines, which are substances that are found naturally in your body, as well as in certain foods, such as steak, organ meats and seafood.
Other foods also promote higher levels of uric acid, such as alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose).
Risk factors
These are factors that increase the uric acid level in your body and they include:
Diet. Eating a diet that’s high in meat and seafood and high in beverages sweetened with fruit sugar (fructose) promotes higher levels of uric acid, which increases your risk of gout. Alcohol consumption, especially of beer, also increases the risk.
Obesity. If you are overweight, your body produces more uric acid and your kidneys have a more difficult time eliminating uric acid, which greatly increases your risk of gout.
Medical conditions. Certain diseases and conditions make it more likely that you’ll develop gout. These include untreated high blood pressure and chronic conditions such as diabetes, metabolic syndrome, and heart and kidney diseases.
Certain medications. The use of thiazide diuretics (amiloretic, ridaq) commonly used to treat hypertension and low-dose aspirin also can increase uric acid levels.
Family history of gout. If other members of your family have had gout, you’re more likely to develop the disease.
Age and sex. Gout occurs more often in men, primarily because women tend to have lower uric acid levels.
Recent surgery or trauma. Experiencing recent surgery or trauma has been associated with risk of developing gout.
Complications
People with gout can develop conditions such as: Recurrent gout. Some may experience gout attacks several times each year. Medications may help prevent gout attacks in people with recurrent gout. If left untreated, gout can cause erosion and destruction of a joint. Advanced gout. Untreated gout may cause deposits of urate crystals to form under the skin in nodules or lumps called tophi. Tophi can develop in several areas such as your fingers, hands, feet, elbows or Achilles tendons. Tophi usually aren’t painful, but they can become swollen and tender during gout attacks. Kidney stones. Urate crystals may collect in the urinary tract of people with gout, causing kidney stones. Medications can help reduce the risk of kidney stones.
Diagnosis
Tests to help diagnose gout may include:
Joint fluid test. Your doctor may use a needle to draw fluid from your affected joint. When examined under the microscope, your joint fluid may reveal urate crystals.
Blood test. A blood test to measure the levels of uric acid and creatinine in your blood.
But blood test results can be misleading. Some people have high uric acid levels, but never experience gout. X-ray imaging. Joint X-rays can be helpful to rule out other causes of joint inflammation. Ultrasound. Musculoskeletal ultrasound can detect urate crystals in a joint or in a tophus. Dual energy CT scan. This type of imaging can detect the presence of urate crystals in a joint, even when it is not acutely inflamed. This test is not used routinely in clinical practice because it is expensive.
Treatment
Gout medications can be used to treat acute attacks and prevent future attacks as well as reduce risk of complications from gout. Drugs that can be used include:
Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include over-the-counter options, such as ibuprofen and naproxen sodium, as well as more powerful prescription NSAIDs, such as indomethacin or celebrex. NSAIDs, however, carry risks of stomach pain, bleeding and ulcers.
Colchicine. Your doctor may recommend colchicine, a type of pain reliever that effectively reduces gout pain. The drug’s effectiveness is offset in most cases, however, by intolerable side-effects, such as nausea, vomiting and diarrhoea.
Corticosteroids. Corticosteroid medications, such as the drug prednisone, may control gout inflammation and pain.
Lifestyle choices/prevention
Keep your fluid intake high. Stay well-hydrated, including plenty of water. Stay away from sweetened beverages, especially those sweetened with high fructose corn syrup.
Limit or avoid alcohol. Talk to your doctor about whether any amount or type of alcohol is safe for you.
Limit your intake of meat, fish and poultry.
Maintain a desirable body weight.