Gout is the inflammation of a joint due to urate crystals that build up around it. This inflammation results in swelling, pain, tenderness and redness of the joint. Gout usually occurs as attacks that last for a few days or weeks and then subside. These attacks may recur at any time depending on a number of factors. Men are more likely to be affected by gout and the big toe is the most common joint that is affected. However gout can occur in any joint and tends to target the leg and hand joints more frequently.
Causes of Gout
Uric acid is produced as a byproduct of protein breakdown as well as the metabolism of purines. High protein foods include meat while purine occurs in most foods although they are higher in some foods like asparagus, beans, lentils, mushrooms, oatmeal, peas and spinach. Most meats also contain high amounts of purines and offals or meat from animal organs are very high in purines.
Acidic foods like tomatoes and citrus fruits (grapefruit, lemon, orange) are also trigger foods for gout. Alcohol is another contributing factor as well as any diuretic like caffeine containing drinks – tea, coffee, energy and soft drinks.
Uric acid production within the body is a normal physiological process. This uric acid is filtered out of the blood by the kidney and is then passed out in the urine. However in gout, the uric acid is not passed out as efficiently and tends to accumulate in the blood (hyperuricaemia). This is then deposited around the joints where it causes inflammation.
Gout is more likely to occur in families and men over 40 years of age are more frequently affected. Excessive alcohol intake also contributes to the development of gout as well as poorly managed chronic conditions like hypertension, diabetes and high blood cholesterol.
Signs and Symptoms of Gout
The main symptoms of gout include :
- Painful joints particularly those of the feet, leg, hand and arm. The joint is so tender that even the slightest pressure on the skin around it is unbearable.
- Swelling where the joint appears to be have ballooned out.
- Redness and heat on the skin may be noticed.
- Difficulty in bending or moving the affected joint.
In most cases the gout attacks will be short lived, lasting a few days or weeks. However even when the attack subsides, there may still be a mild joint ache with discomfort when putting any weight on the affected joint.
If left untreated, gout can lead to a number of complications like nodules around the joint (known as tophi) and hyperuricaemia may also cause kidney stones.
The treatment and management of gout should focus on preventing attacks. When a gout patient is experiencing an attack, anti-inflammatory drugs are necessary to relieve the inflammation. Aspirin should be avoided altogether, even in low doses, as it can often aggravate or trigger another attack.
Colchicine helps with relieving the gout pain as well as preventing future attacks. In severe cases, you doctor may also prescribe corticosteroids. Allopurinol (e.g. Puricos) is a widely used drug for gout and helps to prevent attacks and this has to be taken daily. It may be used for long periods of time and substituted with colchicine if there are any signs of symptoms of a gout attack.
A healthy diet that is specially designed for your needs is essential for preventing future attacks. Typically, a gout diet will increase your daily water intake and reduce your intake of foods that are high in protein and purine. Drinking up to two litres of water a day will allow your kidneys to ‘flush’ out the uric acid although you should discuss this with your doctor if you are suffering with hypertension and using diuretics.
Avoid meat and alcohol as far as possible and knowing which foods are high in proteins and purines will allow you to make an informed decision about your meals. If you eat a balanced diet, you will be able to ensure that you are getting sufficient amounts of all foods without the risk of another gout attack.