HealtH spotligHt
Knowing the facts is
essential when you’re
having to cope with this
painful condition, says
Dr Mel Wynne-JonesG
out is increasing.
Approximately
one in 40 people
in the UK* are affected by
its sudden, severe and/or
recurrent joint inflammation.
National guidelines are
calling for better awareness
and treatment to reduce
damage and improve
sufferers’ quality of life.1Maintain a healthy
weight (lose weight if^
necessary) with diet and
exercise. Choose plenty of
fruit, veg and fibre, low-fat^
dairy foods, less salt, and
less red meat to reduce gout
and cardiovascular risk- heart attacks and strokes.
2Reduce foods that
contain gout-linked^
purines, such as seafood.
You can download the
UK Gout Society’s diet leaflet
at ukgoutsociety.org.3Drink plenty of water^
(two litres a day if
you’ve had kidney stones)^
and be sure to avoid
getting dehydrated.4Drink alcohol only^
within recommended^
limits (no more than
14 units a week – visit^
nhs.uk/livewell) and^
avoid sugary/fructose^
containing soft drinks.The causes
Gout is caused by tiny
crystals of uric acid, which
develop suddenly inside
joints, usually related to
high blood levels of uric
acid (produced by cells
and excreted by the kidneys).
These can build up when
excretion is affected by
our age, kidney function,
menopausal status,
weight, diet, alcohol
consumption and
medical conditions
such as high blood
pressure, diabetes or
psoriasis, or if we take
diuretics, blood-pressure
pills, low-dose aspirin or
some cancer drugs. Gout
occasionally runs in families,
and can also trigger kidney
damage and/or stones.The symptoms
An attack of gout produces
sudden painful inflammation
and swelling in one or more
joints, particularly toes, feet,
ankles, knees, fingers, wristsand elbows; skin becomes
red, hot and shiny, and
moving the joint or the
slightest pressure can be
excruciating. Attacks can
last several days and may
become more frequent,
severe, or widespread.
Recurrent damage can lead
to long-term arthritis.
Gout sometimes affects
tendons, too, and tophi
(firm chalky urate nodules)
may develop around joints
and the ears.Tests you may need
Blood uric acid levels can
fall during attacks, so are
best measured in between.
Uric acid crystals can also be
detected in joint fluid (which
can be obtained with a fine
needle and local anaesthetic).
Blood and fluid tests
may also be needed if joint
infection is suspected (for
example if it’s your first
attack, or you have a fever).
An ultrasound or MRI
scan can reveal gout crystals.
Blood tests can also show
how your kidneys are
working, and whether
you have diabetes or an
alternative cause for your
inflamed joints (you may
need X-rays, too).The treatment
The British Society for
Rheumatology’s guidelinesemphasise the importance of
understanding gout, how to
reduce attacks, and taking
immediate action when
they strike.
Acute gout is an emergency- your GP may prescribe a
maximum-dose non-steroidal
anti-inflammatory drug and/
or colchicine to reduce the
inflammation, depending on
any other medical problems.
They can have side effects,
such as stomach irritation,
vomiting or diarrhoea.
You should rest and elevate
affected joint(s), applying
ice packs (wrapped in a tea
towel) for 20 minutes every
four hours. Using a bed cage
can relieve pressure of sheets
or a duvet resting on it, too.
In severe cases, steroid
tablets or a steroid joint
injection (and fluid drainage)
may also be needed.
Once the attack has settled,
you may be offered long-term
urate-lowering therapy, such
as allopurinol, especially if
your gout started at a young
age, your kidneys aren’t
working properly, you have
tophi, or you have recurrent
attacks (more than half of
sufferers have another attack
within a year).
You’ll be given lifestyle
advice (see box) and if you
have other tablets/diseases,
these treatments may need
to be adjusted as well.
gouT
Get to grips with
*SOURCE: UkgOUtSOCiEty.ORg. PHOtOS: ALAMy, gEtty (POSED By MODEL)a
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4 ways to reduce
gout attacks