Gout is a form of arthritis– of which there are about 100 types– and it is on the rise. Once known as a rich person’s disease (because of its association with protein intake) gout causes sudden excruciating pain and swelling in joints, especially in the large joint in the big toe. It can also affect other joints in the feet, hands, knees, ankles, wrists, elbows, and even tendons and soft tissues. It often occurs for the first time after an injury or illness and usually affects only one joint at a time, but it can progress to affecting several joints at once.
An attack of gout can leave the sufferer with severe pain for days or weeks, and can be so painful that even the weight of a bed sheet is enough to cause unbearable pain. The attack subsides after a time, but the condition often recurs, either in the same joint or another.
What Causes Gout?
Gout is caused by uric acid crystals (monosodium urate) accumulating in the affected joint. Uric acid is a natural waste product of cell breakdown that is normally excreted by the kidneys, but if the kidneys are damaged or there is too much uric acid present it can remain in the bloodstream and collect in joints or in the kidneys, where it can cause kidney stones. The crystals can also form small white lumps (tophi) under the skin.
Some people suffer from gout even though their levels of uric acid are normal or low, and there are also people with high uric acid levels who do not have gout. The reasons are not fully understood.
The level of uric acid in the bloodstream depends to some degree on the diet. Alcohol and shellfish are particularly known to produce higher uric acid levels. Some medications (such as diuretics, chemotherapy drugs, immunosuppressants and aspirin) also increase uric acid levels in the blood.
How Common is Gout?
According to a recent paper in Rheumatology, the prevalence of gout rose from 2.9/1000 people 5.2/1000 people between 1990 and 1999. It is more common in middle-aged men, menopausal women, and in people with pre-existing conditions such as kidney disease, high blood pressure or diabetes. It is also prevalent in the obese.
Diagnosis of Gout
Gout can mimic other forms of arthritis but a doctor familiar with the condition will often be able to make a diagnosis from symptoms such as sudden excruciating pain in the big toe. Laboratory tests for uric acid may be ordered, and fluid may be extracted from the affected joint or tophi and examined under the microscope for the presence of crystals.
Treatments for Gout
Treatments focus on two stages: the first is medication to relieve the pain and inflammation; the second is long-term treatments and lifestyle changes to prevent or reduce further attacks.
Traditional medical treatments include non-steroidal anti-inflammatory drugs (NSAIDS) such as naproxen (Naprosyn) or indomethacin (Indocin), since these drugs quickly reduce the inflammation and hence the pain. Anti-inflammatory drugs can cause stomach irritation or ulcers if taken for long periods so they are usually prescribed only for short periods and often along with a proton pump inhibitor (PPI), which reduces the risk of damage to the stomach and digestive system.
The initial treatment choices will depend on what other medications the patient is already taking, and on the medical history. For example, NSAIDS cannot be taken by patients who are on blood thinners such as warfarin or aspirin. Alternatives include corticosteroids in pill form or injected directly into the affected joint, or colchicine, but both these options also have side effects.
Natural alternatives to medication for the pain and inflammation include simply resting and elevating the affected joint. An ice pack held on the joint for 20 minutes every two or three hours can also relieve the pain and reduce swelling.
When considering long-term changes, allopurinol or febuxostat, which both reduce the amount of uric acid produced by the body, may be prescribed as a urate-lowering therapy (ULT) that aims to reduce uric acid to below levels at which crystals form.
Natural alternatives for long-term treatment include reducing the amount of purine consumed in the diet because uric acid is formed during the breakdown of purine. Foods rich in purine include shellfish, oily fish, caviar, red meats, organ meats such as liver and kidneys, and products or supplements containing yeast. High protein diets and high carbohydrate diets also increase uric acid production, while cherries and blueberries are said to reduce uric acid levels. A balanced diet featuring lots of fruits and vegetables and plenty of fresh water (to flush the kidneys) is ideal for preventing attacks of gout.
Another recommended lifestyle change to help prevent or reduce the incidence of gout is to reduce alcohol consumption or eliminate it altogether. Beer and stouts contain purine in the brewer’s yeast and are particularly to be avoided.
Finally, reducing weight to ideal levels is important over the long term because obesity is a risk factor for gout and other forms of arthritis. A sensible diet and increased exercise is better than crash dieting.
Gout is becoming more common, possibly because of the rise in obesity, but with a few lifestyle and dietary changes, the likelihood of developing this painful condition