Gout

What is gout?

Gout is a common joint disease, which affects about 1 in 100 people. Men are two to three times more likely to be affected than women. It can occur any time after puberty (although usually after the menopause in women as oestrogens have a protective effect), even to those who consider themselves reasonably fit. There may be a family history of the condition.

Gout is caused by a problem with the way that the body metabolises a chemical called uric acid. As a result, high levels of this acid occur in the blood. In an acute attack, urate crystals precipitate out, or are deposited in the soft tissues – most commonly in a single joint. The most common joint to be affected is the one at the base of the big toe, but it can affect the knee, ankle, wrist, foot and small joints of the hand. In fact any soft tissues can be affected and gouty tophi (lumpy collections of urate crystals) may occur in places such as on the ears or elbows.

Symptoms of gout

In general uric acid levels have been raised in the blood for as much as two decades before gout itself appears. So in men for example, uric acid levels rise at puberty while symptoms tend to appear in the mans 30s to 50s.

Some precipitating factors include a family predisposition (genetics), increasing age, kidney disease, rare abnormalities of metabolism, and drug treatments such as certain diuretics or 'water tablets' used to treat high blood pressure or heart failure.

Gout typically causes acute attacks which flare up very suddenly. The joint becomes hot, red and exquisitely tender within about 24 hours. If untreated the attack usually subsides within a couple of weeks.

Most people who have gout end up having a second attack six months to two years later.

In some cases, more and more joints become involved (although the intensity of inflammation may not be so great). In the worst cases, there may be constant pain from chronic inflammation and destruction of the joint.

There's also a risk that crystals will form in the kidneys, leading to inflammation, scarring and kidney stones.

Gout - treatment and recovery

Attacks of gout last a few days and usually improve rapidly if a course of non-steroidal anti-inflammatory drugs (NSAIDs) is started immediately. Sometimes a drug called colchicine or a steroid injection into the joint is needed.

To help prevent further attacks of gout (with the aim of controlling levels of uric acid in the blood):

• Avoid food rich in a group of chemicals called purines - this includes offal, oily fish, pulses and poultry
• Avoid excessive alcohol intake (alcohol can increase uric acid levels)
• Minimise your intake of soft drinks sweetened with sugar (but not artificial sweeteners) or fructose (fruit sugar) - recent research has shown these can significantly increase the risk of gout among men
• Keep your weight within reasonable levels (overweight people are at higher risk of gout)
• Avoid aspirin, as this increases blood levels
• Follow a drug treatment that inhibits the formation of uric acid (such as allopurinol) or increases its excretion by the kidneys (such as probenecid)
• Check with your doctor if you're on regular medication because a number of medicines (for example, diuretics) can cause raised levels of uric acid in the blood, as can one or two diseases, which should be ruled out

Most people with gout lead a completely normal life and manage to keep attacks to a minimum.