Gout

Gout is a type of arthritis, which is inflammation of the joint (arth = joint, itis = inflammation). Although it can affect almost any joint such as the knee, ankles, wrists, elbows etc., it most commonly affects the big toe, making it red, swollen and painful to touch. The onset of pain can be quite fast, and can last for several days, making it difficult for the patient to walk. In severe cases, the patient can be incapacitated.

What causes gout?
Gout results from an accumulation in the body of a chemical called uric acid, which is produced by the breakdown of purines, a substance contained in certain foods. Although, usually, the body eliminates uric acid by expelling it (in urine, faeces and sweat), some circumstances can lead to an accumulation of the substance.

The excess uric acid will then crystallise in the joints – typically the big toe. If these crystals are allowed to build up and form hard lumps (tophi) within the cartilage and bone of the joints, they can eventually cause permanent damage in the form of osteoarthritis. However, while foods high in purine, such as sardines, mussels and liver can precipitate a gout attack, food is not the only cause of the condition. Other factors that can produce a build-up of uric acid in the body include alcohol, sugary drinks, diabetes, kidney problems, high blood pressure and obesity. Gout tends to be more common among older people, especially men, and genetics is also thought to play a role.

Prevention
Although there are medications that prevent the build-up of uric acid in the body, simple dietary changes can also have a big effect. Cutting down on purine-rich foods can make a real difference, as can reducing alcohol intake. Other preventative measures include losing weight (if appropriate), reducing the consumption of sugary drinks and making sure that you drink enough water (8 glasses each day is the recommended minimum). It’s also important to make sure that any other medications that are being taken are not causing gout.

Treatment
There are several approaches to the treatment of gout. These, like the treatment of many illnesses, can be divided into two general categories  - medical intervention and lifestyle changes.

Medical intervention
These work by either providing symptomatic (pain) relief or by addressing the cause of the problem. Pain relief is usually provided with anti-inflammatories such as Diclofenac and Naproxen, though they don’t actually remove the uric acid from the body, so the underlying problem still remains. Other medications address the root of the problem by blocking the production of uric acid or helping the kidneys to eliminate uric acid. These medications must be prescribed by your doctor, and may cause side effects such as headaches, diarrhoea and nausea (to name just a few).

Lifestyle changes
Avoiding purine-rich foods is extremely important. These include shellfish, liver, heart and oily fish such (such as sardines and mackerel). However, many other foods contain purines, too, and you should ask your GP if in doubt. Other changes that can help to clear up gout is cutting down on alcohol (especially beer), losing weight (if you’re overweight) and keeping well hydrated.