Gout affects many individuals here in Anguilla, especially men – and women who live past menopause. Gout can be extremely painful and debilitating, but treatments are available to help relieve the symptoms and prevent further attacks.
What is gout?
Gout is a type of arthritis in which small crystals form inside and around the joints. It causes sudden attacks of severe pain and swelling. Gout can cause redness and tenderness in joints – often the joint at the base of the big toe. An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire. The condition affects mainly men over 30, and women after the menopause.
What causes gout?
Gout is caused by a build-up of a substance called uric acid in the blood.
If you produce too much uric acid, or your kidneys do not filter enough out, it can build up and cause tiny sharp crystals to form in and around joints. These crystals can cause the joint to become inflamed (red and swollen) and painful.
Things that may increase your chances of getting gout include:
• obesity, high blood pressure and/or diabetes
• having a close relative with gout
• kidney problems
• eating foods, such as red meat and seafood, that cause a build-up of uric acid,
• drinking too much beer or spirits and drinks sweetened with fruit sugar (fructose)
• the use of thiazide diuretics — commonly used to treat hypertension — and low-dose aspirin can also increase uric acid levels
Experiencing recent surgery or trauma has been associated with an increased risk of developing gout.
What are some signs and symptoms of gout?
The signs and symptoms might vary in severity from one person to another, but they almost always occur suddenly — often at night — and without warning. Some of the more common signs and symptoms include the following:
• severe pain in one or more joints
• the joint feeling hot and very tender
• swelling in and around the affected joint
• red, shiny skin over the affected joint
Symptoms develop rapidly over a few hours and typically last three to 10 days. After this time the pain should pass and the joint should return to normal.
Almost everyone with gout will experience further attacks at some point, usually within a year.
Gout usually affects the large joint of your big toe, but it can occur in your feet, ankles, knees, hands and wrists.
Diagnosis
If you have signs and symptoms suggestive of gout, you should see your doctor. It is important that a diagnosis is confirmed because other conditions that require urgent treatment, such as an infected joint, can sometimes cause similar symptoms. Your doctor might arrange a number of tests and other investigations to confirm the diagnosis. Your doctor may recommend a blood test to measure the levels of uric acid and creatinine in your blood. Blood test results can be misleading, though. Some people have high uric acid levels, but never experience gout, and some people have signs and symptoms of gout, but do not have unusual levels of uric acid in their blood.
Treatment
Once the diagnosis is confirmed treatment can be instituted for gout. The following might be recommended:
• Relieve symptoms during an attack. This can be done using ice packs and by taking medications such as non-steroidal anti-inflammatory drugs (NSAIDs), colchicine or corticosteroids
• Prevent further attacks. Through a combination of lifestyle changes, such as losing weight or changing your diet, and taking medication that lowers uric acid levels, such as allopurinol
With treatment, many people can reduce their uric acid levels sufficiently to dissolve the crystals that cause gout – and as a result have no further attacks. However, lifelong treatment is usually required.
Medications are the most proven, effective way to treat gout symptoms. However, making certain lifestyle changes may also help. These include:
• Limiting alcoholic beverages and drinks sweetened with fruit sugar (fructose). Instead, drink plenty of nonalcoholic beverages, especially water.
• Limiting the intake of foods high in purines, such as red meat, organ meats and seafood.
• Exercising regularly and losing weight. Keeping your body at a healthy weight reduces your risk of gout.
What are some complications of gout?
Sometimes gout can lead to further problems, particularly if it is left untreated.
Complications include the following:
• Recurrent gout. Some people may never experience gout signs and symptoms again. But others may experience gout several times each year. 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 called tophi (TOE-fie). Tophi can develop in several areas such as your fingers, hands, feet, elbows or Achilles tendons along the backs of your ankles. Tophi are usually not 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.
Conclusion
A common cause of many men and some women seeing their doctor is gout. Gout is a kind of arthritis. It can cause an attack of sudden burning pain, stiffness, and swelling in a joint, usually a big toe. Gout can be successfully treated but various lifestyle changes are important for prevention of this condition.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge MB BS DGO MRCOG, is an Obstetrician/Gynaecologist and Family Doctor who has over thirty-two years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
