What can I do to banish my painful gout?
Q
I HAVE gout in my ankle and, at the age of 90, it’s making my life a misery. It seems to get worse in the evening, with pain and itching.
Putting my foot in a bowl of icy-cold water gives me slight relief. Is there anything else I can do or any foods I should avoid? Mrs M. Alderman, Pontyclun, Wales.
A
Gout can cause intense pain and swelling in the joints. Indeed, many sufferers describe the sensation as being the worst pain imaginable.
It occurs as a result of high levels of uric acid in the blood — uric acid being the waste product from the breakdown of purines (a chemical compound found in many types of food and drink). Crystals of uric acid collect in the joints, causing inflammation and pain.
Not everyone with high uric acid levels will develop the condition, though the reason why is unclear.
What we do know is that 5 per cent of the population will develop gout. Risk factors include age (it occurs most commonly in those aged over 65), obesity, high blood pressure and kidney disease, as these all boost the body’s production of uric acid and slow its natural clearance.
other risk factors include drinking too much alcohol or soft drinks with high levels of high‑fructose corn syrup, or eating a diet that includes a lot of meat and seafood, as these all contain high levels of purines.
Gout typically affects one joint. the pain will come on suddenly and is normally accompanied by redness and swelling.
Symptoms usually improve after a few days and subside within a couple of weeks. An acute attack can be suppressed using anti‑inflammatory steroids such as prednisolone tablets; more commonly, we prescribe nonsteroidal anti‑inflammatory drugs (NSAIDs), painkillers such as indomethacin or naproxen.
It may be that your doctor is reluctant to advise you to try any of these on account of other medication you’re taking (the medications listed above are all contraindicated in patients taking anticoagulants, because such a combination significantly increases the risk of bleeding from the stomach).
Another option that might be suitable for you is colchicine, derived from the autumn crocus, which can counter a flare‑up by reducing both the build‑up of uric acid crystals in the joint and the inflammation. It is not contraindicated if you are on anticoagulants, though it can cause side‑effects such as diarrhoea, nausea and abdominal cramps.
once an attack of gout has settled, treatment can begin with a regular long‑term medication, to lower the level of uric acid and prevent future attacks.
Most commonly prescribed is allopurinol, which works by reducing the amount of uric acid made by the body. It will be some months before it takes effect.
this is something to discuss with your doctor.
In answer to your question about the foods you eat, changes to your diet may reduce the frequency of gout attacks, with uric acid levels potentially being lowered by as much as 15 per cent and more than that in those who are overweight.
In the past, we recommended a diet low in purines. But, because purines occur in such a wide variety of foods — from spinach and mushrooms to liver — this can prove restrictive.
Nowadays, the suggested eating plan is the DASH (Dietary Approaches to Stop Hypertension) diet, which involves an increased proportion of protein from low‑fat dairy products, reduced red meat, seafood and saturated fat, along with replacing white carbohydrates with wholemeal versions.
there is also evidence that eating cherries — ten, twice daily — is of benefit to patients with gout in preventing recurrence.
this is because cherries contain bioflavonoids and anthocyanins, compounds that reduce levels of uric acid and also have an antiinflammatory effect — though the details of these mechanisms are not yet fully understood.
Drinking four to five cups of coffee each day is also associated with a lower risk of attacks, but further studies on this are awaited.
I suggest asking your GP for a referral to a dietitian for guidance on how to adhere to the DASH diet. A little advice will go a long way and, at your age, since there may be other health issues, some expert help is advisable.
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