Wednesday 22 November 2017

Gout attacks are no cause for embarrassment

Gout can cause sudden and sever pain in any joint
Gout can cause sudden and sever pain in any joint

Dr Nina Byrnes

I recently attended my doctor because my toe was very painful and swollen. She told me I have gout and gave me some painkillers which did help. It seems to have settled now but her diagnosis has me worried. Does this mean the swelling and pain will come back? I thought gout happened in people who drink and eat too much. I consider myself quite healthy. Is there any other cause?

I'm glad that you saw your doctor and that the pain went away. Many people associate gout with over-indulgence and, for this reason, many of those who suffer with gout are embarrassed to mention it to their friends or peers. The truth is that gout is simply one form of arthritis. It causes sudden severe attacks of pain, swelling and redness in a joint.

Gout occurs more commonly in the base of the big toe but can in fact occur in any joint.

The incidence of gout is thought to be on the increase and recent studies suggest it affects up to one in 40 adults. 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. An attack usually eases over about seven to 10 days and as it passes the skin may scale a bit or become itchy and purple in colour.

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. Recent studies also suggest that a high intake of fructose-containing drinks plays a role. Drinking two fructose-sweetened drinks a day can increase the risk of gout by up to 85pc.

Gout is usually diagnosed by seeing the changes in a joint but can be confirmed by checking uric acid levels in the blood. The treatment of an acute attack involves taking anti-inflammatory medication such as diclofenac, elevating the joint, resting and applying ice packs to reduce inflammation. In those who cannot take anti-inflammatory medication a substance called colchicine can be used. 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.

Allopurinol can cause a flare when it is first given so it is normally started several weeks after an attack. Your doctor can then monitor the levels of uric acid in the blood and adjust the dose accordingly.

There are also a number of new medications available for those who don't tolerate allopurinol and these can also be quite effective.

You mention you feel fairly healthy and don't drink 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 of 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 well-being and ensure your uric acid levels have fallen since the previous attack. She may also prescribe you 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 gouty attacks returning.

One thing to remember is that gout, although painful, is rarely serious. 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.

Irish Independent

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