Dear Dr Nina: I have just been diagnosed with gout. Can I ever be cured?
Q I am a 45-year-old man who has recently been diagnosed with gout. I do have a fairly unhealthy lifestyle - I drink more than the recommended units, but not much more, and I don't exercise much. My question is, can I reverse this diagnosis by changing my lifestyle?
Dr Nina replies: Gout occurs due to a build-up of uric acid in the blood that then settles as crystals in a joint causing irritation and inflammation. Uric acid is produced in blood and excess amounts passed out through the kidneys. In most people with gout the kidneys don't clear enough uric acid allowing it to build-up in the blood.
However, other factors may cause excess uric acid to build up in the blood. Drinking too much alcohol can cause uric acid levels to rise, foods such as red meat, offal, poultry and certain fish contain high levels of purines which can also increase levels. This is why this condition has been associated with over-indulgence. We now also know that obesity, kidney damage, high blood pressure, diabetes, certain medications and blood and bone marrow disorders also increase the risk. Drinking two fructose sweetened drinks a day can increase the risk of gout by up to 85pc.
The truth is that gout is simply one form of arthritis. It causes sudden severe attacks of pain, swelling and redness in a joint. Men are more commonly affected than women, but the rates increase in women after menopause. It appears most commonly in middle age. There is a family history of the condition in about one in five people who experience attacks of gout.
Gout usually occurs as an attack. A joint may become suddenly very swollen red hot and the pain is intense and severe. Gout is usually diagnosed by seeing the changes in a joint, but can be confirmed by checking uric acid levels in the blood. If uric acid levels remain high in the blood after an attack or recurrent attacks occur, a tablet called allopurinol is often added to help reduce levels of uric acid in the blood.
You mention you feel fairly unhealthy and drink perhaps a bit too much alcohol. Lifestyle management is very important in managing the risk of gout attacks. It is important to stay well hydrated drinking at least two litres water daily. Keep alcohol to a minimum. Eat a varied healthy diet and try to avoid foods that may be high in purines such as red meats, offal and seafood. Low-fat dairy options seem to provide some protection and can be a good alternative source of protein. Do ensure a full check-up with your doctor, discuss any medicine or supplements you are taking and have bloods to check for general wellbeing and ensure your uric acid levels have fallen since the previous attack. You may be prescribed some anti-inflammatory medication to take at the first sign of any future attack.
One study did suggest that those who have decent levels of vitamin C have a reduced risk of gout. Subsequent research didn't back this up, but it does serve as a reminder that a generally healthy diet that is high in wholegrain, fruit and veg and low in rich processed food may help reduce the risk of the gout attacks returning.
One thing to remember is that gout, although painful, is rarely serious. It cannot be cured, but if you keep uric acid levels within normal flares are less likely to occur. In those who have frequent recurrent attacks small nodules may appear in joints and the risk of blood pressure and kidney stones is increased, but for the majority of sufferers maintaining control of uric acid in the blood is enough to keep things at bay.
Health & Living