Gout

What is gout?

Gout is a form of arthritis caused by too much uric acid in the blood. High levels of uric acid do not always cause gout but in some people, uric acid in the blood leads to crystals forming in the joints and this can trigger an attack of gout.

Some people will only have one or two attacks of gout and then no more but if the gout attacks continue, the gaps between the attacks tend to get smaller and joint damage starts to happen. If the gout attacks are still not treated, over several years or decades, uric acid crystals can collect to form firm white lumps called tophi, especially at the ends of the fingers and toes, but also in other places such as the Achilles’ tendons or ears. These tophi can become inflamed or infected and can be extremely painful.

 

Who gets gout?

Gout sometimes runs in families. It is much more common in men, especially as they get older but it also occurs in women, especially after the menopause. It is also more common in people who take certain medicines such as diuretics (water tablets) for blood pressure. Gout is more common in people who are overweight and who drink alcohol, especially beer and it is also more common in people with high blood pressure and who have high levels of cholesterol in the blood.

 

What are the symptoms of gout?

Gout attacks usually come on quite suddenly, often at night and cause the affected joints to be hot, red and swollen. Many people describe gout as the worst pain they have ever had. Some people cannot bear for the joint to be touched because it is so painful. Gout usually affects one or two joints at a time, especially the big toe joints, ankles, knees and feet but also sometime the wrists, fingers and other toes. Attacks usually last for a few days to a week and then gradually improve.

 

How is gout diagnosed?

Gout is caused by uric acid crystals in the joints which can trigger attacks of severe pain, redness and swelling. The only way to be completely sure that an attack of arthritis is actually gout, is for some of the fluid inside the joint to be examined under a special microscope and for the crystals of uric acid to be seen. As the joints which are affected by gout are often very small, it can be difficult or impossible to get a sample of joint fluid and so the diagnosis of gout is often made by the history and appearance of the joints during an attack and by detecting high levels of uric acid in the blood. During an acute attack of gout, the levels of uric acid in the blood can often be normal, so this can delay the diagnosis for some people. Many people with gout have a family history of gout, take certain drugs such as diuretics, and many are overweight, have high blood pressure and may drink more than the recommended amounts of alcohol.

 

How is gout managed?

Some people only have one attack of gout in their lifetime and this is often managed with simple measures such as resting the joint, ice packs or non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen or diclofenac.

If attacks are frequent, in order to prevent more attacks, medicines which lower the level of uric acid in the blood such as allopurinol or febuxostat are usually needed. The lower the uric acid level, the lower the risk of more attacks. These medicines are usually needed for life. During the first few months after starting allopurinol for gout, you may have more attacks. These can be prevented by taking other medicines at the same time, for example NSAIDs or colchicine which are usually stopped after 6 months.

 

What can I do to help myself?

Gout is a curable condition and there is a lot that you can do to help yourself. If you have been prescribed tablets to lower the level of uric acid in your blood, you should continue to take these tablets because if you stop or forget to take them, an attack of gout is likely. The lower the level of uric acid in your blood, the lower your risk of gout attacks and joint damage.

If you can reduce the level of uric acid in your blood by changing your lifestyle, you may be able to reduce the number of gout attacks that you have and may reduce your need for medicines. There are lots of ways that you can help reduce the level of uric acid in your blood for example by reducing your alcohol intake, especially beer, by keeping to a healthy weight and by eating a healthier diet.

  • Reduce alcohol intake – Beer, fortified wine and stout are best avoided if you have gout and you should try to reduce your alcohol intake per week to less than 14 units if you are a woman and less than 21 units if you are a man. The less alcohol you drink, the lower your risk of an attack of gout and if possible try to have at least 3 days per week when you drink no alcohol.

 

  • Lose some weight – If you are overweight, losing even a few pounds can really help reduce the level of uric acid in your blood and therefore your risk of gout attacks. It is very important to avoid very low calorie or “crash” diets as these can trigger an attack of gout. High protein diets such as the Atkins diet should also be avoided for the same reason.

 

  • Avoid dehydration – Drink plenty of fluids, especially water. Up to 2 litres of water or other fluids daily is recommended. Try to avoid drinks sweetened with sugar or corn syrup and high fructose juices as these can all increase the risk of gout. Diet or low calorie drinks are all safe if you have gout.

 

  • Watch your diet – Reduce the levels of high purine foods in your diet such as read meat. Liver, kidneys, shellfish and yeast extract should be avoided and overall protein intake should be reduced. Increase your intake of skimmed milk or yoghurt. Try to increase your intake of vegetable protein for example soya beans, and eat cherries or drink cherry juice.

 

  • Take more exercise – You should not exercise affected joints when you are having an attack of gout, but increasing your level of activity generally is usually good for people who have gout because it can help with weight loss and reduce the risks of high blood pressure, diabetes and heart disease which are all common in people with gout. If you have an attack of gout and it is very painful, it is likely that you will need some pain relieving medicines. These may be anti-inflammatory medicines such as naproxen or ibuprofen or more simple pain relieving tablets such as paracetamol or codeine which will usually need to be prescribed by your doctor.

 

  • How can I help myself during an attack of gout? –  Resting inflamed joints can help- avoid too much exercise or walking when the joints are hot and swollen. Ice packs or a packet of frozen peas wrapped in a tea towel can be useful and may be just as effective as non-steroidal anti-inflammatory tablets during an attack. Elevating the inflamed joint can also help, such as resting your foot on a chair or stool.

 

FAQs about gout

Q. Where does uric acid in the blood come from? 
A. Most uric acid in the blood is made naturally in the body from the breakdown of cells. Some uric acid comes from substances called purines in the food we eat, especially in red meat, offal and shellfish and from alcohol, especially beer. Gout sometimes runs in families and in these families there is a tendency to inherit high blood levels of uric acid.

 

Q. What triggers an acute attack of gout?
A. Sometimes there is no particular trigger for an attack of gout, but attacks can often be triggered by certain factors and therefore knowing these factors can help prevent an attack. Avoiding dehydration is important as becoming dehydrated can trigger an attack, for example, people who have had surgery and who are unwell in hospital can often have a first attack of gout. Dehydration after drinking alcohol can also set off gout.

 

Q. What should I do if I get an attack of gout?
A. If you have an attack of gout and it is very painful, it is likely that you will need some pain relieving medicines. These may be anti-inflammatory medicines such as naproxen or ibuprofen or more simple pain relieving tablets such as paracetamol or codeine which will usually need to be prescribed by your doctor.

 

Q. Can avoiding certain foods help gout?
A. Gout is caused by too much uric acid in the blood leading to crystals of uric acid in the joints which can then trigger very painful attacks of hot, swollen joints. Most of the uric acid in our body is formed naturally and the levels of uric acid depend on what we inherit from our parents – gout often runs in families. Some uric acid in the blood, however, comes from purines in the food we eat. Foods high in purines include offal such as liver and pâté, red meat and shellfish, as well as from the breakdown of alcohol, especially beer. If you have gout, the uric acid levels in your blood can be reduced by weight loss, avoiding purines from animal sources and yeast extract, and by keeping alcohol intake to 1-2 units per day or less. You can also help reduce the number of gout attacks you have by drinking plenty of fluids, especially water, but you should avoid drinks sweetened by sugar or too much fruit juice as these can trigger an attack. Diet drinks are fine. Increasing your intake of cherries either as fruit or juice, and drinking skimmed milk may also help prevent gout attacks.

Read more about different types of arthritis