Gout

Gout occurs when uric acid builds up in the bloodstream and deposits urate crystals in the joint. These crystals form slowly over months or years and can cause:

• sudden, severe episodes of pain
• tenderness
• redness
• warmth
• swelling.

Gout occurs more frequently in men than women, and is also found in people:

• from certain population groups (e.g. Maori)
• with psoriasis (a skin condition where cells build up and form itchy, dry patches)
• who consume a purine rich diet (red meat, seafood)
• who drink alcohol excessively, especially beer, whiskey, gin, vodka, or rum

Certain health conditions are also associated with developing gout, including high cholesterol, high blood pressure, diabetes and heart disease.

Several types of medication can also raise your uric acid levels, especially diuretic drugs (causing increased passing of urine) and some anticancer drugs along with drugs that suppress the immune system.

If members of your family have gout, you are more likely to develop it.

A person with gout is more likely to have an attack when they:

• have elevated levels of urate in the blood
• consume too much alcohol (particularly beer)
• consume a diet high in 'purines' such as meat, sweetbreads, offal, shellfish and fructose (found in fruit juices and soft drinks sweetened with corn syrup)
• are overweight or obese
• use diuretics
• have type 2 diabetes, high blood pressure or high cholesterol – these conditions can mean that your kidneys are less able to flush out the urates
• kidney disease
• injure a joint
• have an operation
• become dehydrated
• are unwell with a fever
• crash diet or fast.

For many people, the first symptom of gout is an excruciating pain and swelling in the big toe – often following a trauma, such as an illness or injury. Gout may also appear in another lower-body joint, such as the ankle or knee. Subsequent attacks may occur in other joints, primarily those of the foot and knee, before becoming chronic.

Gout usually affects one joint at a time, but if left untreated it can affect many joints.

To diagnose gout, your family GP will look at your affected joint and perform a blood test. Your doctor might also remove fluid from the affected joint and examine it under a microscope for uric acid crystals. Finding uric acid crystals in the joint fluid is the surest way to make a gout diagnosis.

Once the diagnosis is confirmed, your doctor will consider various treatment options including:

• non-steroidal anti-inflammatory drugs (NSAIDs)
• colchicine medication
• corticosteroids injections or tablets.

Dealing with an attack of gout

Without treatment the attack usually resolves itself within one or two weeks, but with medication, it can be resolved within several days. However, the crystals still remain in the joint. In an acute attack, applying an ice pack to the painful joint for 10 to 15 minutes at a time and protecting or resting the joint can help to reduce pain.

Living with gout

Adopting healthy lifestyle habits is a key part of an effective gout treatment plan. Eating a healthy diet, engaging in regular physical activity and losing weight if needed can lower your risk of repeated gout attacks, as well as the chances of developing heart disease, which is common in people with gout.

Diet

Certain foods can lower your uric acid levels, including:

• skim milk and other low fat dairy products
• whole grain foods
• plant oils (olive, canola, sunflower)
• vegetables
• some fruits (those that are less sweet)
• vitamin C supplements (500 to 1,000 milligrams daily)
• coffee – if you already drink it
• water

While some foods are known to trigger gout attacks, including:

• red meat and organ means (liver, tongue and sweetbreads)
• shellfish such as shrimp and lobster
• sugary beverages
• excessive alcohol (more than one alcoholic drink for women and two for men within 24 hours)
• Consult a dietitian to get advice on a healthy and well balanced diet.

Weight loss

If you do need to lose weight, make sure your weight loss is gradual as 'crash' diets can increase uric acid levels.

• Cut down on alcohol consumption and avoid binge drinking.
• Keep hydrated – drink plenty of water.
• Exercise regularly – aim to complete at least 30 minutes of physical activity most days of the week.
• Work closely with your family GP to prevent further attacks and actively manage your condition.