Would you Know if you had Gout?



Gout can be a right royal pain in the foot. Anyone who has had the tell-tale painful, swollen red toe of gout will tell you it’s not something you would want to have once, let alone multiple times. Things gout sufferers may not know however is that it doesn’t just affect joints in your foot – it can also affect large joints like the ankle, knee hand and wrist causing severe pain and disability. There’s more to gout to meets the eye – and as always, the best medicine is prevention.

What is gout?

Gout is a collection of crystals in a joint, called ‘urate crystals’ (monosodium urate). These crystals are visible under a microscope if a sample is taken, and can understandable cause considerable inflammation and resultant pain, causing large amounts of friction and irritation in the synovium of the joint. This commonly affects just one joint at a time, but can cause disease in multiple joints. The most common joint it affects is the first meta-tarsal phalangeal joint, at the base of your big toe – inflammation of this due to gout is commonly referred to as podagra.

What does gout look like?

A joint affected by gout will rapidly become, swollen, tender and often pink or red. It will be tender to touch and many patients affected by podagra will avoid walking or bearing weight on the affected foot. In chronic aggressive disease, occasionally a build up of crystals in the joint which manifest just under the skin’s surface can cause unsightly growths called tophi. These are benign growths that look a bit like blobs of cheese, but are understandably cause distress to the gout sufferer. Gout may persist for a few days or up to a couple of weeks, depending on treatment and chronicity of the disease.

What causes gout?

Gout is commonly caused by an overproduction of uric acid through a number of complex steps in the breakdown of cell components. Dehydration is a key risk factor, especially in warmer temperatures, for developing gout and as such drinking lots of water (and not cold beers!) is a good preventative measure.

Foods and drinks that are highly associated with onset of gout are:

  • Seafood
  • Alcohol, especially beer or spirits
  • Liver and kidney
  • Sweetbreads/offal
  • Some medications can increase your risk of gout such as:
  • Furosemide (Lasix)
  • Aspirin
  • Cytotoxic medications as in chemotherapy
  • Other diuretics
  • Gout can also be precipitated by trauma, illness, surgery, stress, starvation and states of high-cell turnover such as cancer or chemotherapy.

How do you treat gout?

The short term of goal of treating gout is to get you back on your feet and pain-free as quickly as possible. You should see your GP in the first instance to make sure this is gout.

First line treatment for gout is prescription of a non-steroidal anti-inflammatory (NSAID) such as Nurofen (ibuprofen) or indomethacin. This is an affordable medication and taken daily, will alleviate symptoms and help the disease resolve more quickly.

If you have a history of renal disease or gastric ulcers you may be prescribed colchicine.

The third option is corticosteroids either delivered into the joint directly or given in an oral form. This is rarely the norm, however.

Gout can have some harmful long-term effects, such as tophi (the unsightly growths mentioned earlier), joint desctruction and permanent disability, and kidney stones. For these reasons, it is important to have good long-term control and prevention of gout. Two lifestyle factors that can be modified to prevent gout are dietary modification and weight loss.

If you have had multiple attacks in the past it may be beneficial to start a course of allopurinol, a drug that reduces the production of uric acid. This is generally started about a fortnight after resolution of your last attack and will require several weeks to months of treatment. During this time your blood uric acid levels should be checked until they are below a desirable level. Treatment should be continued for 3-12 months after reaching the target level of uric acid.

Take home messages:

  • Gout can be a recurrent difficult condition, and often affects the big toe
  • Dietary modification can help prevent attacks
  • See your GP if you think you may have gout or acute joint pain!

References:

  • Badlissi, F. (2018). Gout. [online] Bestpractice.bmj.com.proxy.library.adelaide.edu.au. Available at: http://bestpractice.bmj.com.proxy.library.adelaide.edu.au/topics/en-gb/13/management-approach [Accessed 17 May 2018].
  • Guidelines for preventive activities in general practice. (2012). Victoria, Australia: Royal Australian College of General Practioners.

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