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Gout

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Gout

What is gout?

Gout is a rheumatic condition that predominantly affects middle-aged men. It is ten times more common in men than in women. The most common site for an attack of gout is the joint at the base of the big toe. An acute attack of gout can be extremely painful.

"The joint at the base of the big toe is the commonest site for an acute attack of gout."

What causes it?

Gout is caused by a build-up of uric acid in the blood. This results in the formation of sodium urate crystals in the joints. Uric acid itself if a by-product of the breakdown of certain types of waste products. In the vast majority of people, it is eliminated from the body during urination. However, among those who are susceptible to gout, the uric acid builds up in the bloodstream and deposits itself in crystal form in the joints. The crystals cause irritation within the joint giving rise to the acute inflammation we recognise as gout.

Are there different types of gout?

There are two different types of gout:

  • Primary hyperuricaemia refers to an increased level of uric acid in the blood. This type of gout is usually caused by a hereditary abnormality in the kidneys, which renders the body incapable of excreting uric acid fast enough.
  • Secondary hyeruricaemia is the more common form of gout seen in most doctors' surgeries. It can be a result of some other medical condition. It can also be caused by diuretics (fluid tablets) or alcohol. Some people experience gout when they eat certain foods.

What are the symptoms?

Gout does not develop overnight. There is a latent period of about seven years during which the concentration of uric acid in the bloodstream gradually increases. This latent period is referred to as 'asymptomatic hyperuricaemia', which simply means high uric acid levels without symptoms. It is important to point out that most of the people who develop this condition will not go on to develop gout.

The first symptom of gout is usually extreme pain in the big toe. The joint at the base of the big toe becomes swollen and the overlying skin becomes shiny and purple. The toe becomes very tender and sufferers find that they are unable to wear a shoe on the affected foot or even tolerate the weight of bed sheets at night.

The first attack of gout will usually subside after about a week and about 10% of people will never again experience gout. The remainder may experience attacks with increasing frequency and each subsequent attack can be of longer duration. Repeated attacks of gout over several years can cause arthritic damage to the joint.

While gout most often affects the big toe it can also attack other joints. The knee can sometimes be affected.

If gout is left untreated, the sodium urate crystals will eventually collect under the surface of the skin and will manifest themselves as small bumps near the joints, or more commonly on the outer side of the ear. These bumps are known as Tophi and occasionally they rupture and discharge a yellowish, chalky material.

How is it diagnosed?

Gout is usually diagnosed on the basis of the history of the attack and the physical signs. In order to rule out other rheumatic conditions, your GP will probably take a blood sample to measure the concentration of uric acid in the bloodstream.

How is it treated?

Gout is usually treated with non-steroidal anti-inflammatory drugs. Painkillers that lack anti-inflammatory activity will not give adequate relief since the joint inflammation is the actual trigger factor for the pain. Most attacks of gout will subside within a week. Once the inflammation has disappeared the medication can be discontinued.

If a person suffers from frequent recurrences of gout they may need long term medication in order to keep the levels of uric acid within normal limits. They may also need to modify their lifestyle. These measures might include:

  • avoiding foods which experience has taught may trigger an attack of gout. Generally these foods are high in protein and contain chemicals known as purines. The list includes anchovies, sardines and any foods based on offal such as kidneys and liver.
  • weight reduction if you are overweight.
  • reducing alcohol consumption.
  • drinking lots of water in order to wash out the urinary system. Excessive levels of uric acid in the kidneys can lead to the formation of 'calculi' or kidney stones.

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