Gout is a common and complex form of arthritis that causes sudden and severe joint pain, most commonly occurring in the big toe. The skin surrounding the joint will often appear swollen, red and feel tender to touch. Gout is caused by a build-up of uric acid in the joints, largely down to food and drink that is consumed including alcohol, red meat and certain seafood. Taking regular pain relief and staying hydrated during an attack of gout can help you feel more comfortable.

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Gout Treatments

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Advice for Gout

What is Gout & what causes it?

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.

What are the symptoms of Gout?

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.

How is Gout diagnosed?

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.

How can I treat Gout?

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

How can I prevent Gout?

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.

Alternatives

Alternative OTC (Over The Counter) & Non-Medicinal Medication for Gout
How to relieve symptoms during and attack- This can be done by using an ice pack on the affected area, as well as taking anti-inflammatory drugs (NSAID'S), the over the counter medicine for this would be Ibuprofen (Nurofen), they will be available at any local pharmacy or supermarket.
Also a lifestyle change may well be required, for example losing weight will drastically help as well as a change in diet. It will be helpful to keep your URIC ACID levels as low as possible. There are prescription medications available to do this. You should consult your GP to learn more.


Gout FAQs

  • Gout is a form of arthritis known as inflammatory arthritis. The condition affects the body’s joints, causing severe pain and swelling of the affected area. Gout can be experienced in any of the body’s joints, though in the majority of cases it tends to affect the fingers, toes, wrists, ankles, elbows and knees.
  • Gout is a condition brought on by an excess of uric acid in the blood. Normally, this chemical is excreted in the urine. If too much uric acid is produced, or if not enough of it is excreted, it can build- up and form needle-like crystals. These crystals can settle in any of the body’s joints, triggering painful inflammation and swelling in the surrounding tissue.
  • Gout is a fairly common condition that affects approximately 1-2 people out of every 100 in The United Kingdom. The condition tends to be most prevalent in men over 30 and postmenopausal women. Overall, gout is more common amongst men.
  • Uric acid is a chemical produced when the body breaks down another chemical called purines. Purines are a substance found in certain food and drinks. Most uric acid is dissolved in the blood, where it will travel through the kidneys before being excreted in the urine. If your body has too much uric acid, or if it is unable to remove enough of it, this build-up can lead to gout. High levels of uric acid in the blood is called hyperuricemia.
  • The main symptoms of gout are as follows:
    • A sudden, intense pain in one or more of the body’s joints.
    • A swelling of the affected area directly around the joint.
    • The affected joint will feel hot and be tender to the touch.
    • The surrounding skin will become red and inflamed.
  • There are a number of factors that put a person more at risk of developing gout. These include:
    • Age and gender – the condition is more common in adults over 30 years of age and affects more men than women.
    • Genetics – having a blood relative with gout increases your likelihood of developing the condition.
    • Weight – being overweight significantly increases your risk of experiencing gout.
    • Drinking alcohol – alcohol can interfere with the removal of uric acid from the body, which can lead to gout.
    • Diet – eating foods that are rich in purines can cause, or exacerbate gout in some people.
    • Medications – certain types of medication can increase the risk of developing gout. These include; diuretics, salicylate drugs, niacin, cyclosporine, and levodopa.
    • Health problems – certain health issues can lead to gout, including; high blood pressure, hypothyroidism, psoriasis, haemolytic anaemia, Kelley-Seegmiller syndrome, and Lesch-Nyhan syndrome.
    • Recipients of organ transplants – having received a transplanted organ increases your susceptibility to gout.
  • Gout can sometimes be difficult to identify, as the symptoms often mimic other conditions. To gain a firm diagnosis, your doctor will ask about your symptoms and examine the affected area. They will likely review your medical history and ask relevant questions about your diet.
    If your GP still isn’t sure whether gout is the accurate diagnosis, further testing will likely be required. This can include:
    • Blood tests – which would look to measure the concentration of uric acid in the blood.
    • A joint fluid test – this will involve taking a fluid sample from the affected joint, which can then be analysed and checked for the gout causing crystals.
    • Ultrasound scan – this is becoming an increasingly popular method for diagnosing gout. Ultrasound uses sound waves to build up an internal picture, which will help detect the gout causing crystal formation in the joints.
  • Food and drink that are rich in purines should be avoided. These include:
    • Beer
    • Spirits
    • Red meats
    • Organ and glandular meat, including; liver, kidneys and sweetbreads.
    • Certain seafood, including; herring, haddock, sardines, scallops, anchovies, mackerel and tuna.
  • Medicines used to either treat or prevent gout include:
    • Nonsteroidal anti-inflammatory drugs (NSAIDs) – these include Ibuprofen, Naproxen, Indomethacin, and Celecoxib. These medicines are used to control the inflammation, whilst providing effective pain-relief. Always check with your doctor or pharmacist before using NSAIDs to ensure their suitability.
    • Colchicine is a prescribed medication that can be used to both treat and prevent a gout attack. Using colchicine every day for prevention may reduce the frequency of gout attacks, though it will not prevent the accumulation of uric acid that can lead to joint damage.
    • Corticosteroids, such as Prednisolone are generally prescribed when NSAIDs and colchicine are unsuitable.
    • Allopurinol – this medicine works to inhibit the production of uric acid. Allopurinol is designed to help prevent gout attacks from occurring. However, if an attack should occur, allopurinol will not provide any pain relief. This preventative treatment is taken once daily, everyday.
  • Gout attacks can be severely painful and debilitating. However, with the appropriate treatment and self-help techniques, the symptoms can be effectively controlled. Below is an outline of what to do to ease the pain during an attack:
    • Take your prescribed medicine – this can be over-the-counter or prescribed painkillers, such as Ibuprofen or Naproxen. If you are already taking a prescribed uric acid-lowering drug, continue to take this medicine during an attack.
    • Ice down – applying an ice pack to the affected joint, will help to ease the pain and inflammation.
    • Drink plenty of fluid – ensuring you stay hydrated will help the body to flush out the excess uric acid from your system. You should aim to drink around 16 cups of fluid a day, with at least half of those being water.
    • Avoid alcohol – it is important to avoid alcohol during an attack, especially beer. Alcohol not only causes the body to produce more uric acid, it will also inhibit the excretion of uric acid from your body.
    • Elevate the affected joint and keep pressure off of it – raising the affected joint above chest height will help reduce the swelling.
    • Try to relax – stress can aggravate gout, so it recommended to try and relax as much as possible during an attack.
    • Avoid high-purine foods – these foods could exacerbate or prolong a gout attack.
    • Inform your doctor – if your current medication regime isn’t controlling or relieving your gout symptoms, your doctor may wish to prescribe alternative or suggest stronger treatments.
  • Gout normally develops after years of uric acid crystal build-up. You probably won’t be aware that your uric acid levels are elevated until you suffer your first gout attack. However, there are preventative measures you can take, which will help ward off developing the condition. These include:
    • Avoid food that is rich in purines.
    • Reduce the amount of alcohol you drink.
    • Stay hydrated.
    • Regular exercise.
    • Avoid sugary drinks and sugary snacks.

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