...less medical jargon in a 'Quick Glance' format!
Gout is one of the most common forms of arthritis. It appears as an acute attack often coming on overnight. Within 12-24 hours there is severe pain and swelling in the affected joint. The skin over the joint may be red and shiny.
This disease usually affects only one or two joints at a time - most often the feet and ankles. The ball of the big toe is the commonest site. Without treatment the attack subsides in a week or so and when patients first develop gout there may be intervals of many months or even years between attacks. As time goes by, these tend to become more frequent and more severe and eventually many joints may be involved, sometimes all at the same time. At this stage a state of chronic or continuous joint disease may develop with progressive joint damage, disability and crippling. Gout affects mostly men and is very rare in women until after the menopause when it is quite often seen. Some surveys have shown it to be present in up to 10% of adult males.
extreme tenderness in a joint, usually a big toe joint
Causes: Uric acid is a chemical which is a natural part of the normal breaking down and building up of food and body tissues. The level in the blood can be measured and shows how much there is in the body overall. The condition of raised blood uric acid is called hyperuricaemia. When this is present the uric acid which is normally dissolved in the blood may, from time to time, form microscopic crystals in the joint. These crystals set up the inflammation which is called acute gouty arthritis or acute gout.
It follows that this disease may develop in persons whose uric acid is higher than normal. There are many causes of this. The following are some of the more common causes:
Higher than normal levels of uric acid can be part of the inherited make-up of some families
High alcohol intake
High intake of food containing purines (see below)
Some of the drugs used to treat high blood pressure
Less commonly, longstanding kidney disease may result in high blood levels of uric acid
Treatment: The first step wherever possible must be to correct those factors mentioned above which give rise to high uric acid levels. Purines are substances found in food, which, when broken down produce a lot of uric acid. Therefore the following foods which are high in Purines should be restricted or avoided:
Offal foods such as liver, kidneys, tripe, sweetbreads and tongue
Excessive amounts of red meat
Shellfish, fish roe and scallops
Peas. lentils and beans
Alcohol intake should be reduced. Two glasses of beer a day or less is sensible
Weight loss may be very important
Medication for high blood pressure may need to be altered
. . . Treating the Acute Attack: One or other of the anti-inflammatory drugs (NSAIDs) can be very effective but to gain the best results the dose should be adequate and the drug taken as soon as possible at the first sign of an attack. Hence medical advice must be sought early. With effective treatment the attack may be controlled within 12-24 hours and treatment need not be continued after a few days. Rest and elevation of the part involved and a fluid intake increased by an extra 4 or 5 glasses of water a day are also important. Drugs used for the acute attack have no effect on reducing uric acid levels.
. . . How to Lower Uric Acid: If in spite of all the measures above the uric acid remains high and attacks continue or become more frequent, other drugs can be used which directly lower the blood uric acid. However, it must be understood that these drugs have no effect on the actual attacks of acute gout and they must be taken on a continuous and long term basis. The dose must be adjusted by repeated checks on the blood uric acid before a permanent maintenance dose can be decided on. Once the uric acid is down within normal limits, the patient should remain free from gout provided the drug is continued. Some drugs work by increasing elimination via the kidneys and others by blocking uric acid formation.
It is also very important for patients beginning such drugs to realize that for the first few months of treatment, gouty attacks can become more severe and frequent. This is usually controlled by taking one or two tablets a day of an additional drug for at least several months and if any acute attacks do appear they must be treated in the usual way and the long term medicines continued.