Here’s what causes Gout and how to treat it

Gout is a common type of arthritis that can affect anyone. People with gout will experience severe pain, swelling, redness and tenderness in one or more joints, most often in the big toe.

The attack can occur suddenly at night while you’re sleeping with the sensation that your big toe’s on fire. Symptoms may come and go but there is medication to help you manage the pain and inflammation.

Doctors usually diagnose gout based on your symptoms and the appearance of the affected joint – there are also tests that confirm the diagnosis. Untreated gout can lead to worsening pain and joint damage.

Symptoms

The signs and symptoms of gout include:

• Severe joint pain. This is usually in the big toe, but can occur in any joint like the ankles, knees, elbows, wrists and fingers.

• Discomfort in the joint lasting a few days to a few weeks.

• Swelling and redness of the affected joint

• Stiff joints that are difficult to move.

Causes

Your body breaks down proteins called purines and produces uric acid. Purines are also found in foods including red meat and organ meats such as liver and kidneys.

Purine-rich seafood includes anchovies, sardines, mussels, scallops, trout and tuna. Alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose) promote higher levels of uric acid.

High uric acid in your blood forms crystals. Gout occurs when uric acid crystals accumulate in your joint, causing inflammation and intense pain of a gout attack.

Risk factors

Factors that increase the uric acid level in your body include:

• A diet rich in red meat and shellfish, alcohol and beverages sweetened with fruit sugar (fructose) will increase levels of uric acid, which increase your risk of gout.

• When you’re overweight, your body produces more uric acid and your kidneys have a more difficult time eliminating uric acid.

• Certain medical conditions increase your risk of gout, like untreated high blood pressure and chronic conditions such as diabetes, obesity, metabolic syndrome and heart and kidney diseases.

• Medication like aspirin and some hypertension medication can also increase uric acid levels.

• A family history of gout will also put you at risk.

• Gout occurs more often in men, primarily because women tend to have lower uric acid levels. However, after menopause, women’s uric acid levels approach those of men.

• Recent surgery or trauma. Experiencing recent surgery or trauma can sometimes trigger a gout attack. In some people, receiving a vaccination can trigger a gout flare.

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Complications

Untreated or poorly treated gout will lead to the following complications:

• Some people may experience recurrent or repeated attacks of gout which can lead to the erosion and destruction of a joint.

• Untreated gout may cause deposits of uric acid crystals to form under the skin in nodules called tophi.
  They develop in areas such as your fingers, hands, feet, elbows or Achilles tendons. Tophi usually aren’t painful, but can become swollen and tender during gout attacks.

• Kidney stones. Uric acid crystals may collect in the urinary tracts of people with gout, causing kidney stones.

Treatment

Medication is used to reduce the inflammation and the pain of gout attacks and to prevent complications by lowering the amount of uric acid in your blood.

Medication

Nonsteroidal anti-inflammatory drugs include over-the counter options such as brufen, naproxen, indomethacin or Celebrex.

The risk with these is stomach pain, bleeding and ulcers. They should only be used under the guidance of a medical professional.

Colchicine may be recommended because it can effectively reduce gout pain. The risks are side effects such as nausea, vomiting and diarrhoea.

Corticosteroids such as prednisone may control gout inflammation and pain. Side effects of corticosteroids may include mood changes, increased blood sugar levels and elevated blood pressure and therefore should not be over used.

Medications to prevent gout complications

If you have proof of gout damage on joint X-rays or you have tophi, chronic kidney disease or kidney stones, medications to lower your body’s uric acid levels may be recommended.

Medications that block uric acid production include allopurinol and febuxostat, which help limit the amount of uric acid your body makes.

Side effects of allopurinol include fever, rash, hepatitis and kidney problems. Febuxostat side effects include rash, nausea and reduced liver function. It may also increase the risk of heart-related death.

Medications that improve uric acid removal such as probenecid help improve your kidneys’ ability to remove uric acid from your body. Side effects include a rash, stomach pain and kidney stones.

Prevention

Drink water instead of alcoholic beverages and drinks sweetened with fruit sugar.

Avoid foods high in purines. Red meat and organ meats, such as liver, are especially high in purines. Purine-rich seafood includes anchovies, sardines, mussels, scallops, trout and tuna.

Exercise regularly and lose weight. Keeping your body at a healthy weight reduces your risk of getting gout.

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