Gout
is one of the commonest forms of arthritis (joint inflammation). 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.
Gout 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 de\develop with progressive joint damage. disability and crippling (chronic gout). Gout affects mostly men and is very rare in women until after the
menopause when it is quite often seen. Gout is very common in New Zealand and it is particularly common in Maoris and Pacific Islanders. Some surveys have shown it to be present in up to 10% of adult males.
What causes Gout?
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 gout 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
- Obesity
- 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 of Gout
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. On special occasions vou can drink more.
- 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 (NSAIDSs) 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 (Hyperuricaemia)
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 dost 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 realise 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. Complications of Gout
Where high uric acid has been present for a long time and acute gout has been frequent and
severe, deposits of uric acid salts may appear around the affected joint and even in tissues elsewhere such as the ears. These are seen as chalk coloured nodules called tophi. Their presence indicates the need for
treatment with one or other of the long term uric acid lowering drugs mentioned above. High uric acid levels and recurrent gout are often associated with high blood pressure which your doctor will check and treat as
necessary. This combination of hyperuricaemia and high blood pressure can lead to kidney damage so it is all the more important, not just because of the effects on the joints, to correct this state of affairs through
the proper use of all the measures mentioned above under your doctor's supervision. Unproven Remedies
The promises of quick "cures" and "miraculous relief' sound
wonderful to a person with a chronic illness. Most of the products advertised in this way whether drugs, dietary supplements or mechanical devices are not harmful but worthless and expensive. To avoid falling into these
traps people should discuss with their doctor any other fonrns of treatment they are considering. Gout hurts so much that you will need your doctor's help to get rid of it. The most usual place to get gout is in your
big toe and that's not funny even if your friends do laugh! Pain in other joints especially in your feet and ankles can be caused by gout too. Gout is verv common in Maori and Pacific Islanders and men seem to get it
more than women. Some of your fami~' may also have pain caused by gout and it is possible that your parents or grandparents had it too. You can't change these things just as you can't cure gout but you can avoid having
more bad attacks of this very painful condition. You Can Help Yourself Get Rid of the Pain Here are a few tips to help you:
- Your doctor will give you pills to take.
- Take them every day.
- If you think the pills make you feel worse talk to the doctor about changing the tablets but DONT STOP TAKING THEM.
- Try to keep your weight down.
- Ask your doctor or health worker to give you good advice about diets that will help you do this.
- Some foods will make your Gout much more painful. Try to cut down or avoid:
- Red meats which come from cows or sheep and include steak, chops, corned beef and larger pieces of meat usually roasted in the oven.
- Brains, kidneys, liver & heart (offal).
- Shelifish such as pauas, pipis, mussels, oysters and sea eggs.
- Peas and beans.
- Alcohol. especially beer and wine.
The pain caused by Gout will go away. If you are careful you can avoid having more bad attacks of Gout. taken from the NZ Arthritis Foundation pamphlet |
