Gout

Gout is a form of arthritis that causes small crystals to form in and around the joints. The main symptom of gout is a sudden attack of intense pain, coupled with swelling of the affected area.

The condition is fairly common, affecting approximately 1-2 people in every 100 in the UK. Gout tends to affect men over the age of 30 and postmenopausal women. Overall, the condition is more prevalent in men.

The small crystals that cause gout are produced when a waste product called uric acid starts to build-up in the body. Uric acid is formed when the body breaks down chemicals called purines. If the body begins producing too much uric acid, the excess will build-up, eventually turning into microscopic crystals. These crystals tend to form in and around the body’s joints, which is thought to be due to the slightly lower body temperature found in those areas.

If the crystals work their way into the spaces between the joints, this can cause the severe pain, swelling and inflammation associated with gout. The pain associated with gout can be both severe and debilitating. However, there are available treatments that will help relieve the symptoms and help prevent future bouts.

Gout can strike in any of the body’s joints, though in most cases, it tends to affect the toes, ankles, fingers, wrists, elbows and knees. The most common symptoms of gout include:

• Sudden, intense pain in one or more joints
• Swelling of the area directly around the affected joint
• The surrounding skin turning red and shiny
• The affected joint feeling hot and tender.

The above symptoms can develop very quickly, usually over the course of a few hours. On average, an episode of gout will last between three and ten days, after which the pain and swelling will subside. As the swelling goes down, the affected skin can become itchy and flaky.
 
Sadly, almost every sufferer of gout will experience a repeat attack at some point. Some sufferers will experience attacks every few months. For others, bouts of gout can come every few years. If left untreated, the attacks can become more frequent.

It is recommended to visit your doctor if you suspect you have gout without it having been previously diagnosed. This is especially true if your symptoms are severe or accompanied by a high temperature of 38°C or above. In most cases, your doctor will be able to diagnose gout based on your symptoms. They will also examine the affected joint and review your medical history. They will likely ask about your diet, specifically your intake of foods and drinks that are high in purines. These include:

• Beer
• Spirits
• Red meats
• Organ or glandular meat, such as liver, kidneys and sweetbreads
• Selected seafood, such as anchovies, herring, sardines, mussels, scallops, trout, haddock, tuna and mackerel

Further testing may be required to confirm the diagnosis, or to rule out other potential causes. These tests can include:

• Blood tests – which will look to measure the amount of uric acid in the blood. High levels of uric acid would be associated with gout
• Joint fluid test – this test involves taking a sample of fluid from the affected joint. The sample can then be analysed and checked for gout causing crystals.
• Ultrasound scan – this method is becoming increasingly popular to help detect crystals in the joints. Ultrasounds are also effective for picking up crystal formation deep in the skin, which can easily go unnoticed during a physical exam.
• X-ray – gout is rarely detectable on an X-ray. However, this method can be helpful in assessing any joint damage caused by gout. Also, X-rays can help rule out any similar joint conditions, such as chondrocalcinosis, which is a build-up of calcium crystals in the joints.

Gout treatment includes medicines that will help manage the pain during an attack and medicines that will help prevent future attacks.
 
NSAIDs:

The first line of treatment for gout is usually non-steroidal anti-inflammatory drugs (NSAIDs). This group of pain-relieving medicines will help manage the pain and reduce the associated inflammation. Examples of NSAIDs used to treat gout include;

• Naproxen
• Diclofenac
• Etoricoxib

These medicines are often prescribed alongside another medicine called a proton pump inhibitor (PPI). This is because NSAIDs can increase the risk of indigestion and stomach irritation, which the PPI will help to counter. If you have been prescribed NSAIDs for gout, it is recommended you keep them with you. This will ensure you are able to take them straight away at the onset of an attack. You should continue taking NSAIDs during your attack, and for 48 hours afterwards.
 
COLCHICINE:
 
If NSAIDs are unsuitable or have proven ineffective, then a drug called Colchicine can be used instead. Colchicine will help ease swelling and relieve the pain during a gout attack. Like with NSAIDs, you should make sure you keep it with you at all times, so if a gout attack occurs they are on hand to take immediately.
The dose of Colchicine will be determined by your doctor. When taken in high doses, Colchicine can potentially produce side-effects, such as nausea, stomach pain, and diarrhoea.
 
CORTICOSTEROIDS:

In more severe cases of gout, a short course of steroids called corticosteroids can be prescribed. This line of treatment is usually reserved for when NSAIDs or colchicine have proven ineffective. Corticosteroids are not intended for prolonged use at high doses, as they can cause a variety of unpleasant side-effects, including:

• Weight gain
• Osteoporosis
• Weakening muscles
• Easy bruising

ALLOPURINOL:

Allopurinol acts to inhibit the production of uric acid. This has the advantage of helping to prevent gout attacks from occurring. However, if an attack should strike, allopurinol will not provide any pain relief. Allopurinol is taken once daily, every day. During the initial stages of treatment, regular blood tests will be required to monitor the uric acid levels in your blood. This will help identify the most effective dose for you.
 
In some cases, allopurinol can trigger a gout attack. This typically happens soon after treatment is commenced. For some, it can take up to two years before gout attacks are eliminated completely. Even if this is the case, it is important to persevere with treatment, as in the long-run the benefits of taking allopurinol will outweigh the temporary disadvantages. Pain relief, such as NSAIDs and colchicine can be used alongside allopurinol during these initial stages.
 
Allopurinol is generally well tolerated, producing little in the way of side-effects. However, side- effects can include:

• Indigestion
• Diarrhoea
• Headaches

There are several ways you can help prevent gout attacks, ranging from lifestyle changes to medication.
 
Urate-lowering therapy (ULT) uses medicines, such as allopurinol, to reduce the levels of uric acid in the blood. This line of treatment is usually recommended for people who suffer recurrent attacks, and for those who experience further complications from their gout, such as joint damage or kidney stones.
 
Adopting certain lifestyle changes can also help reduce the risks of experiencing gout. These changes include:

• Avoiding foods that are rich in purines, such as red meat, oily fish, seafood, offal, and foods that contain yeast extract.
• Cut down on alcohol consumption, especially beers and spirits.
• Staying hydrated – drinking plenty of water will help prevent gout causing crystals from forming in the joints.
• Avoid sugary snacks and drinks – such products are linked with an increased risk of gout.
• Exercise regularly – try to choose activities that put less stress on the joints, such as swimming.
• Weight loss – sticking to a healthy weight and following a balanced diet will help reduce the chance of suffering from gout.