Gout is a disease caused by an excess of uric acid in the blood. This can be due to an overproduction of uric acid or by failure of the body to excrete a sufficient amount. The medical term for this is hyperuricaemia. It can also be triggered by medicines such as water tablets (diuretics) or aspirin. This excess of uric acid causes crystals to form in the blood, which collect around the joints, causing inflammation and extreme pain. The big toe is most commonly affected, but the knee, ankle, wrist, foot and small joints in the hand can also be affected. The disease is 5 to 8 times more common in men than women.

During an attack, the affected joint becomes extremely painful and you may not be able to put any weight onto it or even bear clothing to touch it. The surrounding skin becomes very shiny and red and often feels hot. It may also be accompanied by a fever. These symptoms are referred to as gouty arthritis. The first attack can last a few days and often starts during the night or in the early hours of the morning. Some people only ever experience one attack, whilst others suffer another attack between six months to two years later. Each attack tends to be more severe and can affect additional joints. The length of time between subsequent attacks also becomes shorter. If you have suffered with gout for several years you may notice the appearance of irregular, creamy coloured lumps (tophi) around the affected joint. These are deposits of accumulated uric acid, which can also appear in soft tissue such as the ear, in the urinary tract (as stones in the kidneys) and around tendons.

How do I Know If I Have Gout?

The symptoms of gout are very similar to other forms of inflammatory arthritis, but tend to affect just a single joint. Once your doctor has eliminated other conditions or causes for the inflammation, you will have a blood test to check the levels of uric acid present in the blood. You may also have fluid removed from the swollen joint (aspiration) and examined under a microscope for the presence of uric acid crystals. Sometimes, an X-Ray of the affected joint is taken. The results of these tests will confirm whether or not you have gout.

Treatment

Your doctor will take into account your medical history and the timescale from the onset of the gout attack and will prescribe the most suitable pain relief for your condition. There is a range of drugs available which all work by reducing inflammation. There are non steroidal anti-inflammatory drugs (NSAID's), colchicine or corticosteroids.If you experience further attacks of gout, your doctor may advise long term treatment with other drugs such as allopurinol, which decreases the levels of uric acid in the blood and helps prevent crystals forming in the kidney and other tissues, or one of the uricosuric drugs such as probenecid or sulfinpyrazone, which increase the excretion of uric acid from the body.

Neither of these courses of treatment can be started until two to three weeks after an acute attack, otherwise the symptoms may be worsened or prolonged. Once treatment has started, additional use of NSAID's or colchicine may be needed in the event of another acute attack of gout, during the initial three months. Response to long-term drugs may be slow but they are usually successful in preventing attacks and helping to avoid deformity in the joints. Untreated gout leads to deposits of crystal forming on the surface of the cartilage, initially causing cartilage damage and ultimately producing extensive joint damage.

Can I Take Measures To Help Ease My Condition?

There are several contributing factors that can lead to increased levels of uric acid in the blood. Some factors you are unable to change, such as a family history of gout or a contributing medical condition. However, you can lessen the risk of another attack by changing your lifestyle to include more exercise, altering your diet by replacing 'bad' foods for 'good' foods and losing weight if necessary.· During your treatment with anti-gout drugs, drink plenty of fluids to help prevent uric acid crystals forming in the kidneys. · It is important to attend the appointments for regular blood tests to monitor the levels of uric acid in the blood.· If you are overweight, ask your doctor or health advisor at the clinic for a diet sheet to help you reduce weight steadily. Do not go on a crash diet, as sudden weight loss can trigger an attack

  • cut down your alcohol consumption especially beer, lager, port and some wines
  • do not take aspirin, as it causes retention of uric aci

Foods To Avoid

Food consists largely of cells which are made from complex chemicals known as purines. The waste product of purines is uric acid. For this reason, foods that are high in purines should be avoided, since they can increase the levels of uric acid in the blood. These include liver, offal, game, kidney, poultry, red meat, sardines, shellfish, fish roes, anchovies, asparagus, beans, cauliflower, lentils, mushrooms, peas, pulses, spinach, mycoprotein (found in meat substitutes) and whole grain cereals.

Foods To Increase

Eat plenty of fresh fruit, leeks and green leafy vegetables as they contain potassium which aids the excretion of uric acid. Other low purine foods include tea, coffee, cheese, eggs, milk and cereal. Cherries are particularly good in helping to lower blood levels of uric acid. A fish oil supplement which contains omega-3 fatty acids may also be beneficial in helping to relieve painful swelling of the joints. Your pharmacist will be able to offer further advise on supplements, should you require it.