Gout is a condition that most commonly causes a painful, red, swollen, hot joint or joints. It is caused by such high levels of a natural chemical (uric acid) in the blood (hyperuricaemia) that crystals begin to form.
Attacks may last a few days to a few weeks and usually there are long periods between attacks.
Mostly, one joint becomes painful, red, hot, and swollen (inflamed) over a very short time. Most often the first joint to be affected is the big toe, just like the popular image of the person with gout, but in up to a third of people the attack starts elsewhere. Sometimes more than one joint, or soft tissues (muscles, tendons, tissues below the skin) may be affected by inflammation.
Sometimes hard, yellowish lumps are visible close beneath the skin (tophi). Crystals may cause troubles elsewhere, sometimes leading to stones in the kidneys.
Uric acid is a natural substance, produced by the body as a by-product of the breakdown of old body cells, and from foods we eat. Most of it leaves the body via the kidneys, in the urine. Some is passed out in the bile.
Most times the cause is inbuilt and not a direct result of drinking or eating the wrong things. Where no other cause is identified it is known as idiopathic gout. About 20% of people with idiopathic gout have relatives who have hyperuricaemia or gout. The inherited problem may be one of over-production or reduced elimination of uric acid via the kidneys.
Certain other conditions, especially affecting the blood, and treatment with some cancer drugs, can cause higher levels of uric acid. Certain food products are high in uric acid (such as offal, meat extracts and fish roe), and alcohol also causes increased levels, by producing another substance (lactic acid) which competes with uric acid for excretion.
Kidney failure can lead to high uric acid levels (hyperuricaemia) as can the use of water tablets (diuretics).
Your doctor will be able to tell a lot from the speaking to and examining you. You may well also have a blood sample taken to test the uric acid level. Sometimes a sample of fluid from a swollen joint, or a crystal from one of the lumps near to the skin surface, may be looked at under a microscope.
When gout has caused a lot of damage to a joint it may show up on an X-ray, but this does not usually help with making the diagnosis in the first place.
In an acute attack, the drugs most likely to be prescribed are the non-steroidal anti-inflammatory drugs (NSAIDs) for example indometacin. These are not usually used if the patient has a history of peptic ulcer or indigestion, or when the patient is on blood-thinning drugs (anti-coagulants), and in certain other cases. If the NSAIDs cannot be used, then your doctor may prescribe colchicine.
If you have a persistently elevated uric acid level and are having frequent attacks of gout, your doctor is likely to suggest the use of a regular preventative (prophylactic) treatment. The most likely suggestion is allopurinol, which is taken daily. This prevents the build-up of uric acid.
An alternative is the use of a drug which causes more uric acid to pass out through the kidneys (a uricosuric agent), for example probenecid.
Your doctor may well continue with the acute treatment when the prophylactic treatment is started, as this may, in itself, cause a flare-up.
- Avoid excesses of alcohol or food
- Lose weight if overweight
- Avoid offal, fish roe and meat extracts