Gout - No laughing matter September 2008
GOUT – NO LAUGHING MATTER
For many reasons, gout is not treated with the seriousness it deserves. Perhaps it is the historic connection with old soaks lying back with their feet up drinking port wine - but whatever the reason, tell a friend you have gout and they are likely to give you the same level of sympathy as for a headache or a sprained ankle.
In fact, gout is a serious complaint that can cause immense pain. It has become a lot more common over the last two decades yet public knowledge about this condition remains minimal.
Gout is a metabolic disorder more common in men than women. It causes acute although intermittent attacks of arthritis in the joints of the foot, knee, ankle, hand and wrist. It is especially common in the big toe which is more incapacitating than it sounds. If gout is left untreated, the attacks can become more frequent, more prolonged and more generalised.
Gout is caused by excess uric acid (urate) in the blood and tissues. After these tissues have been exposed to prolonged supersaturation, crystals of urate can form in and around the joints and kidneys. If these crystals enter the joint, they can trigger inflammation when the affected joint becomes red, swollen and extremely painful and tender.
Most patients with gout have high levels of urate in their blood because they do not pass enough in their urine; this can be because of an inherited peculiarity of the kidneys or by diet or certain drugs such as diuretics. There are some cases when people naturally produce too much uric acid.
Attacks of gout often develop during the night and after a few hours the pain can be so intense you can’t even tolerate a sheet over your foot. The skin may be red and shiny and in some cases the inflammation can be so severe that the skin starts to peel. A mild fever, a loss of appetite and a feeling of tiredness can also accompany gout.
During an attack, the most important thing to do is to relieve the pain by controlling the inflammation and immobilising the joint. Currently non-steroidal anti-inflammatory
drugs (NSAIDs) such as ibuprofen, diclofenac or indomethacin are the most used medications.
Eventually, the attack will die down and the joint will gradually return to normal. This can take a few days.
Once the attack has passed, the next step is to help prevent recurrences. If you are overweight, it is good to reduce your weight to a healthy level. Reducing alcohol consumption can help – especially beer (beer contains yeast, see below) - and it is also good to eat smaller amounts of purine-rich food.
Uric acid is formed from purines which are found in many foods. High purine foods include meat, especially red meat and offal; game such as rabbit and pheasant; seafoods especially shellfish, anchovies, herring, mackerel and sardines; and yeast-containing foods and drinks such as marmite and beer.
Mushrooms and a number of vegetables such as asparagus, cauliflower, spinach, lentils and soya beans are also rich in purines and should be eaten in moderation. There is medical evidence, however, that vegetarian diets high in purines are less likely to lead to gout than diets containing meat or shell fish.
Ideally, you should try to limit your consumption of these high purine foods and instead turn to protein sources lower in purines such as milk, eggs and cheese.
Some people find that certain foods such as strawberries, oranges, tomatoes and nuts will trigger their gout even though they are not high in purines. Although there is no clear evidence to suggest why this happens, it is probably best to avoid them if you have had this experience.
Scientific studies are beginning to confirm the long-held belief that consumption of cherries can be beneficial and there is some recent research to suggest that the risk of developing gout is reduced in people eating a diet rich in dairy products.
If you have taken sensible precautions and still suffer repeated attacks, then there are some long-term drugs to help lower the level of uric acid in the blood. These can only be started when the attack has diminished. The drugs include allourinol, a drug that reduced the production of uric acid in the body; and uricosuric drugs such as probenecid which lowers urate levels in the blood by increasing the excretion of uric acid in the urine.
Despite modern progress, gout remains an exceptionally painful condition – and it certainly should be treated with the seriousness it deserves.
For further information
1. UK Gout Society. Email: email@example.com
2. Arthritis Research Campaign Web: www.arc.org.uk
Email: firstname.lastname@example.org Tel: 0870 850 5000
3. British Nutrition Foundation. Web: www.nutrition.org.uk
Email: email@example.com Tel: 020 7404 6504