Gout is the most common form of inflammatory arthritis. It affects approximately 2.7% of the overall population in New Zealand and 3.75% of people who are over 20.
Gout symptoms usually include severe pain, tenderness, swelling and limited movement at one or multiple joints. People with gout may feel like the skin around the joint is tight, hot, and has a
shiny, red appearance.
These gout attacks tend to start suddenly during the night. It only takes a few hours for the joint to show signs of inflammation (red, swollen, hot and painful). The pain can be so severe that even light pressure may be uncomfortable. An attack of gout lasts for five to ten days, however, it can last for weeks in some rare cases.
Gout is caused by an increase of uric acid in the blood. Two-thirds of uric acid is naturally produced in the body. The other third comes from a chemical called purine, which is found in the food we eat. In a healthy person, uric acid stays dissolved in the blood, and the kidneys excrete it as urine. However, in a person with gout, their blood accumulates too much uric acid. This results in the formation of uric acid crystals which are deposited into the joints causing pain, inflammation, and lumps called tophi.
Gout is usually caused by genetic factors, however, other risk factors and health conditions can increase your likelihood of developing gout. Some of these risk factors include; obesity, high alcohol intake, eating lots of purine-rich food (e.g. seafood or red meats), injury to a joint, kidney disease or certain medications such as diuretics.
How is gout diagnosed
To get a diagnosis of gout a blood sample may be requested to check if there is a higher level of uric acid in the blood. During a gout flare, the uric acid levels are often normal. This is because during a gout attack the excess uric acid has now moved out of the blood and has been deposited as crystals in the joints, so sometimes a blood sample is not always helpful.
To get a certain diagnosis, the doctor may need to take a fluid sample from the joint. This procedure is done under local anaesthetic when a small needle removes some of the fluid. The sample is sent to the laboratory where they test for the presence of uric acid crystals. An X-ray may be taken to see if there has been any damage to the joint.
Treatment of gout attacks
The sooner treatment commences, the faster a gout attack can be controlled. There are a few different medications the doctors might give you to help. Firstly, medications to relieve the pain, and inflammation, such as ibuprofen. Colchicine is a medicine that aims to block the body producing uric acid and is best taken at the beginning of an attack. There are other medications that doctors may give to help with an attack. If you are having a gout flare see your doctor as soon as possible to discuss your options.
With effective treatment the attack may be controlled within 12–24 hours and treatment need not be continued after a few days. Alongside medications, there are also things you can do at home to help the pain, such as:
- rest until your symptoms improve
- raise the inflamed joint and put an ice pack on it
- do not try to exercise during an attack
- take pain relief medication
- Drink plenty of water
If gout is left untreated
If your uric acid levels stay high for long periods of time, or you are having frequent gout attacks, you might develop deposits of uric acid crystals around the joint. This is called tophi and it appears as chalk coloured lumps under the skin. Build-up of tophi can cause permanent damage to the affected joint, and may require surgery to restore the joint. Tophi can be sore and can break through the skin causing ulcers.
Long-standing untreated gout can also cause damage to the kidneys, which can lead to impaired kidney function.
The prevention of gout attacks is equally as important as treating an attack. Gout can be prevented with medications and a few changes to your lifestyle.
The gold standard medication for gout prevention is called allopurinol. This medication’s aim is to reduce uric acid production. It is important to take your medication every day, even during a gout attack. There are some people with gout who get side effects to allopurinol or for other reasons cannot take it, and may be given an alternative medication. It is important to talk to your doctor about long term gout medication, especially if; you are having more than two attacks a year, have joint damage or large amounts of tophi deposits. Medications should only be stopped after talking with your doctor.
There are also some simple lifestyle changes you can make to help prevent gout attacks. Maintaining a healthy body weight is important, as it reduces stress on your joints and decreases the likelihood of developing gout.
Making changes in your diet can help lower your uric acid levels. This can be done by restricting or avoiding high purine foods. Some foods that are high in purines include; shellfish, offal, red meat, yeast extracts such as marmite and vegemite. Limiting alcohol intake is also an important part of preventing gout, especially beer as it is high in purines, and dehydrates the body. If you have gout, it is important to make sure you are drinking plenty of water during the day. This is necessary as it helps to flush uric acid crystals out of your body.
How can a Podiatrist help with gout?
If you have gout, you might find a podiatrist helpful. The big toe joint is the most commonly affected area. A podiatrist can help you find appropriate footwear that will help keep pressure off the joint and reduce pain when walking. They can also look at making a specialised orthotic device for you that offloads the affected joints and may help reduce pain.
If you have tophi deposits that have broken through the skin, a podiatrist can help with keeping the wound clean, and dressing and preventing infections from occurring.
Gout can affect any or multiple joints in the body, and you may find it difficult to cut your toenails or have difficulty reaching down. A podiatrist will be able to help cut your nails, remove any hard skin and track the overall health of your feet.