Living with
Gout

What is gout?

Gout is a common type of arthritis that is caused by the build-up of uric acid in the blood. Subsequent formation of urate crystals in the joints causes intense symptoms in affected joints.

If you have gout, you may experience an extreme pain in the base of your big toe, the most common symptom associated with gout.

 

While symptoms of gout typically come and go, they usually develop very suddenly and may feel very severe. Such times of more severe disease are what are known as “attacks of gout”.
While anyone can get gout, it is more common in men or people with a family history of the condition.

 

Medication can be used to treat gout. However, gout that is left untreated can lead to worsening pain, joint damage and other severe complications.

 

 

 

How do you know you have gout?

The symptoms of gout mostly have a sudden onset, often in the middle of the night, and can include:

  • Sudden and extreme joint pain: While gout can affect any joint, it is most common in the large joint of your big toe/the joint at the base of your big toe. The pain is severe and can last several hours to days.
  • Lingering discomfort: The acute pain usually subsides to some form of joint discomfort, which may last up to a few weeks in duration.
  • Swelling and redness: Inflammation of the joint causes the overlying skin to become red and hot, while the joint will appear swollen.
  • Limited mobility/flexibility: As gout progresses, you may experience limited mobility or flexibility in the affected joint.
  • Tophi: Chronic gout causes little, white lumps to develop in the skin overlying the affected joint.

When to see your doctor:

If you experience sudden, intense joint pain or one of your joints is hot to the touch, then seek medical attention from your doctor or healthcare provider.

 

What causes gout?

Gout is initially caused by a build-up or excess of uric acid in the blood, medically known as hyperuricemia.

Hyperuricaemia is defined as a serum/blood uric acid level of greater than 0.42 mmol/l for men and 0.36 mmol/l for women.
Uric acid is produced when the body breaks down purines (chemical compounds found in high amounts in certain foods, such as red meat, organ meat and seafood). Normally, uric acid is dissolved in the blood and excreted in the urine by the kidneys.
However, if too much uric acid is produced, or not enough is excreted, it can build up. The uric acid then forms needle-like crystals in joints that cause the inflammation associated with arthritis.

 

Factors that increase uric acid levels in your body include:

  • Diet: Eating a diet rich in purines (meat and seafood) increases your body’s levels of uric acid.
  • Alcohol consumption: Alcohol interferes with the normal clearance of uric acid from the body.
  • Age and sex: Gout is more common in men, as men produce more uric acid; however, this becomes less appreciable after women begin menopause.
  • Overweight or obesity: Your body produces more uric acid and your kidneys have a more difficult time eliminating the compound if you are overweight. Furthermore, adipose tissue (fat tissue) produces inflammatory proteins that are known to cause damage to joints.
  • Medical conditions: Certain diseases of the kidney reduce the body’s ability to excrete uric acid. Hypertension and diabetes are also associated with gout.
  • Certain medications: Some medications like diuretics and salicylate or low-dose aspirin can increase uric acid levels in your body.
  • Genetics/Having a family history: You have a greater chance of developing gout if someone in your close family has the condition.
  • Recent surgery or trauma: These are associated with an increased risk of developing attacks of gout.

 

Living and managing

The following dietary guidelines can help prevent attacks of gout:

  • Stay well-hydrated: Drink plenty of water and limit how many sweetened beverages you drink.
  • Limit or avoid alcohol: If you have gout, talk with your doctor about whether you can drink alcohol and if so, how much. Recent evidence suggests that certain alcoholic beverages, particularly beer, are more likely to increase the risk of gout.
  • Eat a healthy diet: Eat only low-fat dairy products and limit your intake of meat, including fish and poultry.
    Additionally, recent studies suggest that certain compounds in low fat-dairy products may also protect against gout. Visit Cooking from Heart to learn about low-fat dairy options and alternative protein sources for a healthy diet.
  • Maintain a healthy weight: This includes eating a low-fat diet and choosing smaller portion sizes at meals.
    Losing weight may help decrease uric acid levels in your body. However, avoid diets that incorporate fasting and rapid weight loss, as these can transiently increase uric acid levels. It is also important to remain active to manage your weight effectively.
  • Incorporate more vitamin C into your diet: Supplements containing vitamin C may reduce uric acid levels in your blood; however, evidence of this is limited. Talk to your doctor about what a reasonable daily intake of vitamin C is for you.
    A healthy, balanced diet will allow sufficient vitamin C intake by incorporating plenty of vegetables and fruits, and you, therefore, may not need any additional supplementation.

 

What treatment is available for gout?

Medications that can help prevent attacks of gout and decrease symptoms. These medications include:

  • Corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids: Steroid therapy and over-the-counter/consumer NSAIDs, such as ibuprofen and meloxicam, taken at recommended doses, can relieve gout pain and help prevent future attacks.
    Courses of corticosteroids, like cortisone, and stronger NSAIDs are available by prescription from your doctor, while NSAIDs can cause stomach, cardiovascular and bleeding problems, as well as liver and kidney damage – so take care to use these medications correctly and only as indicated.
    If you have severe symptoms, your doctor may also consider prescribing you opioid medications such as tramadol.

 

  • Colchicine: This may be prescribed by your doctor to reduce the pain caused by your gout; however, side-effects, such nausea, vomiting and diarrhoea, may decrease its efficacy if take in large doses.

 

If you still experience frequent gout attacks and severe pain, despite taking conventional therapies and eating a healthy diet regularly, then your doctor may prescribe one of the following medications to try and limit potential gout complications from arising:

  • Xanthine oxidase inhibitors that stop uric acid production in the body, and include allopurinol and febuxostat. These medications may cause several potentially serious side-effects, so they must be taken exactly as your doctor or healthcare provider prescribes and may require regular medical supervision.
  • Uricosurics, including probenecid and lesinurad, increase the kidneys’ ability to excrete uric acid.

What are the complications of gout?

People with gout can develop:

  • Recurrent gout: Some people may experience frequent gout attacks, up to several times a year. If left untreated, recurrent gout can cause erosion and destruction of a joint.
  • Advanced gout: Untreated gout can cause deposits of urate crystals to form little, white nodules under the skin called tophi. These usually develop in cooler areas of your body, such as in the joints of the fingers, but they may also occur in other areas, like the hands, feet, elbows or Achille’s heel.
    While tophi are generally not painful, they can become swollen and tender during attacks of gout.
  • Kidney stones: Urate crystals can also collect as kidney stones in the urinary tract of people with gout.
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