What causes Gout?

The main reasons for developing gout are:

Treatment

Treatment of an acute attack

How to lower Uric Acid

Complications of gout

Gout is one of the most common forms of arthritis. It occurs 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 also become red and shiny.

Gout usually affects only one or two joints at a time - most often in the feet and ankles. The ball of the big toe is the most common site. Without treatment the attack subsides in a week or so. When a person first develops 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. Eventually several joints may be involved, sometimes all at the same time. This can then progress to joint damage and disability.

Gout affects mostly men and is quite rare in women until after menopause, when it is more often seen. Gout is very common in New Zealand, particularly in Maori and Pacific Island peoples. Surveys have shown it to be present in up to 10% of all adult males.

Gout often comes on overnight and causes severe pain and swelling in the affected joint.

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What causes gout?

Uric acid is a chemical that is 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 level is called hyperuricaemia. When this is present, the uric acid, which is normally dissolved in the blood, may form microscopic crystals in the joint. These crystals set up the inflammation called acute gouty arthritis or acute gout.

The main reasons for developing gout are:

• Genetic (ie it is in the family)
• Obesity
• High alcohol intake
• High intake of food containing purines (explained below)
• Some drugs for the treatment of high blood pressure
• Long standing kidney disease resulting in high blood levels of uric acid.

Normal. Elimination of waste through kidneys and bladder.	Too Much Uric Acid Being Formed. Overflow inflames gouty joints.	Kidneys not Getting Rid of Extra Uric Acid. Excess uric acid inflaming gouty joints.

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Treatment

The first step must be to determine what is causing the rise in the uric acid levels of the blood. Purines are substances found in food which, when broken down, produce a lot of uric acid. The following foods should therefore be avoided or restricted:

• Offal foods such as liver, kidney, 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 OK.

Weight loss may be very important and medication for high blood pressure may be required or need to be altered.

Treatment of an acute attack

Alchicine and one of the anti-inflammatory drugs (NSAIDs) can be very effective. 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. Seek medical advice early. With effective treatment the attack may be controlled within 12-24 hours and treatment can be stopped after a few days.

Rest and elevation of the part of the body involved, is important. As is increasing the amount of fluid intake by an extra 4-5 glasses of water a day.

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How to lower Uric Acid

If in spite of taking the above measures attacks continue and become more frequent, other drugs are available which directly lower the blood uric acid. These drugs however, do not have any effect on the actual attacks or acute gout and must be taken on a continuous and long-term basis. The dose must be adjusted by repeat checks on the bloods uric acid level before a permanent maintenance dose can be decided on. Once the uric acid level is within normal limits, you should remain gout free providing the drug is continued as prescribed.

It is important to remember that during the first few months of using these drugs, gout attacks can become more frequent and severe. This can be controlled with the use of other drugs and the other methods already described, but the long-term medication must also be continued.

Complications of gout

When uric acid levels have been high for some time and the attacks of gout have been quite frequent and severe, deposits of uric acid salts may appear around the affected joint and even in tissue elsewhere – such as the ears. These are seen as chalky or cream coloured nodules called tophi. This is an indication that the use of the long term drugs is essential.

High uric acid levels and recurrent gout are often associated with high blood pressure,which also needs to be checked and treated as required. The combination of these factors can lead to kidney damage, so it very important to get guidance from your doctor.

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