Gout is a condition that causes intermittent and painful swelling of the joints. Whilst a joint in the big toe is the most commonly affected, gout can commonly attack other joints in the foot, ankle, knee, hand and wrist. If the underlying cause is not treated attacks become more frequent and more severe. Gout is the most common cause of inflammatory joint disease in men over 40.
Gout occurs when there is too much uric acid in the blood. Uric acid is a naturally occurring product of metabolism. Uric acid is sparingly soluble in the blood therefore it can easily come out of solution (crystalise). This is the opposite of dissolving. If uric acid crystallises in the joints then this may trigger inflammation – activation of the immune system. This causes the pain, swelling and erythema (redness) of the affected joints.
In patients affected by gout most have unusually high levels of uric acid in the bloodstream. This is usually because they do not remove sufficient uric acid from the kidneys. Much less commonly some patients may produce too much uric acid in the first place.
Gout most commonly occurs in men over 40 years of age although can occur in men of any age and post-menopausal women. Gout is rare in both children and pre-menopausal women. Men or women who are older, are overweight, have high blood pressure or who consume significant amounts of animal protein, seafood, sugary drinks or alcohol are more at risk of gout. Dehydration, some medications (such as diuretics and some antibiotics) and unusual physical exercise can trigger a gout attack.
An attack of gout is usually extremely painful. It often starts with a twinge in an affected joint in the big toe which becomes hot, swollen, red and extremely painful. An untreated attack will usually settle down in a few days. Subsequent attacks can become more frequent or prolonged and affect other joints.
You may not have any tests at the time of an attack but a blood test can help confirm the diagnosis. High levels of uric acid in the blood suggest gout is more likely but a normal level of uric acid does not exclude gout as a cause. However, a blood test on its own is not usually enough to confirm or exclude a diagnosis of gout. Other tests that may be arranged include taking fluid out of the joint for analysis, an x-ray or other scans.
At the time of a gout attack this may provide an opportunity to screen for other conditions such as high blood pressure, high cholesterol or diabetes as these conditions are more frequent in patients with gout.
Having been diagnosed gout is treated in three ways:-
1. Treatment of the acute attack - It is important to treat an acute attack as quickly as possible. Gout is commonly treated with non-steroidal anti-inflammatory tables (NSAIDs) such as indomethacin, naproxen or ibuprofen. However NSAIDs can have side effects and are not suitable for all patients. Colchicine is an alternative if patients cannot take NSAIDs. Very occasionaly steroid medications (such as prednisolone) are used.
2. Reducing the possibility of a further attack by lifestyle measures - Once the acute attack has settled it is important to take steps to reduce the possibility of a subsequent gout attack. Lifestyle measures – such as altering the diet, losing weight and reducing alcohol consumption – are advised. However often on their own these measures are insufficient to bring down the uric acid level in the blood to target level as often patients are genetically predisposed to gout.
3. Reducing uric acid blood levels by medications - In most patients who have repeated attacks they will need medications to reduce the level of uric acid in the blood. These are started once the acute attack has settled. Allopurinol is the most common medication but other medications are available.
Not only is an attack of gout extremely painful but repeated attacks of gout can lead to progressive permanent joint damage. The attacks become more frequent and more prolonged. Gout is usually extremely straightforward to treat.
