What is gout?

Gout is a painful type of arthritis that can attack both large and small joints, though it usually only attacks one joint at a time. The condition usually begins with pain in the big toe. Other joints that are affected include the wrists, fingers, ankles, knees and elbows.

Gout has been around throughout history and used to be called the disease of Kings, as it used to affect those who were well fed and drank plenty of alcohol.

Gout is much more common in men than women and often occurs after the age of 40. Women who develop gout tend to develop it after the menopause.

What causes gout?

Gout is caused by high levels of a substance in the bloodstream called uric acid, this condition is known as hyperuricaemia. Uric acid normally forms when the body breaks down a natural chemical in foods called purines. Uric acid is also formed by the breakdown of the body's own tissues, such as blood cells. Uric acid is usually removed from the body by the kidneys and taken out of the body in urine. Uric acid levels can become raised if the kidneys, though healthy cannot get rid of uric acid fast enough or the body begins producing too much uric acid, due to an inherited tendency. Uric acid levels will also tend to be higher if you have kidney disease.

When uric acid builds up in the bloodstream it overflows and forms sharp crystals that collect in the joints and soft tissues. The majority of people who have hyperuricaemia (high uric acid levels) will not develop gout.

What are the symptoms of gout?

The first time you get an attack of gout the pain can be very intense and usually happens during the night, even though you may have gone to bed feeling fine. The affected joint swells and the skin becomes a reddish purple colour and feels hot to the touch. The joint can be so painful that even touching it can be an agonizing experience. You may also develop a fever and lose your appetite.

In long standing gout, deposits of uric acid crystals may collect in soft tissue throughout the body (e.g. earlobes and hands), forming small, hard bumps that look like white pimples. These bumps are called tophi and are visible beneath the skin.

The first attack usually subsides in days but on rare occasions can go on and last for weeks.

Am I at risk of getting gout?

You are at risk of having raised uric acid levels and therefore at risk of developing gout if :

• You are overweight.
• You consume large amounts of alcohol, especially beer and red wine.
• You have had major surgery or a sudden severe illness.
• You are taking certain tablets, such as diuretics used to treat heart disease or high blood pressure.
• You have a diet rich in food products, which are high in uric acid, such as kidneys, liver and some seafoods.
• There is a family history of increased uric acid levels.

Can I do anything to prevent getting gout?

To prevent getting gout you should maintain a healthy diet and cut down on alcohol. You should also ensure you get regular exercise, this will help to prevent weight gain.

How is gout diagnosed?

Your doctor will look at your medical history and examine the affected joint. Your doctor will also take a urine and blood sample to look for the presence of raised uric acid levels, though raised uric acid levels do not necessarily mean you have gout.

To confirm a gout diagnosis the doctor may want to take a sample of fluid from the affected joint or from one of the lumps under the skin, to look for the presence of uric acid crystals under a microscope. Your doctor may also suggest you have an x-ray of the affected joint.

How is gout treated?

Fortunately, gout is probably the most easily treated form of arthritis, it is treated in two ways:

• Firstly, during an attack you will be treated with non-steroidal anti-inflammatory drugs (N.S.A.I.D's) to relieve pain and reduce inflammation. With effective treatment the attack can be controlled within 24 hours. You will usually be given some N.S.A.I.D's to keep at home as this enables you to begin treatment at the first sign of a further attack.
• Secondly, if you get frequent gout attacks you will be offered drugs to prevent further attacks. These drugs are aimed at reducing the levels of uric acid and will need to be taken regularly. Your doctor will usually monitor your uric acid levels with regular blood tests.

If the doctor suspects your diet is a contributing factor for you developing gout he/she may recommend you cut down on alcohol and change your diet by avoiding certain foods, such as kidneys, sardines and liver. You should also aim to drink at least 10 glasses of water a day to help flush uric acid out of the body.

If gout is left untreated you may carry on getting attacks, which may last longer and become more frequent. If these attacks continue over several years you may end up with a permanent damaged joint. However, because of successful treatments this is now quite a rare occurrence.