Up until now I only really thought of gout as something that people got years ago from eating rich food. I never even considered the fact that is it is still a very common, debilitating and extremely painful condition that can affect the lives up to 5.1 million adults. (Amer J Kidney Dis 2002;40(1):3742. Data Source: 1988-1994 NHANES)
My father in law has suffered from gout for many years, and has often talked about it on the telephone. I would dutifully ask him how his gout was and he would reply, “Very painful! I couldn’t even bear the weight of the blanket on my foot last night”, and I would tut and tell him to get better quickly.
The last time we went to visit, he actually showed me what gout looked like, and I must say I was horrified at the effect that it had on him. His toes looked like huge purple sausages and he couldn’t bear them to be touched. I felt ashamed that I had not showed much empathy for his pain and was determined to find out about this awful condition.
Gout is a form of arthritis that usually affects a joint in the body, commonly located in the big toe. The condition causes swelling and pain and affects men over 30 to 60 and older people. Although women can suffer from it, the statistics show it to be a predominantly male affliction.
Other areas that can be affected cover the instep, heel, ankle, knee, finger, wrist and elbow. Although some lucky people may only suffer from one attack of gout in their whole lifetime, it is usually a reoccurring condition that can be triggered off by illness, alcohol or too much exercise.
What actually causes gout?
Purines are something that forms a part of the chemical structure of the genes of every living thing on earth. Some foods contain high concentrates of purines and are mostly found in high protein substances such as kidney, mackerel, herring, sardines and mussels, and yeast.
Uric acid is the resulting chemical that is formed after the purines have been assimilated by the body, and is an essential ingredient for our well being, as it serves as an antioxidant and helps to keep our blood vessel linings in good shape.
If the body produces too much urate, it is normally disposed of through the kidneys into the urine. However, if the kidneys cannot pass the urate acid quickly enough, or the body produces too much urate, (known as hyperuricemia), it will have the effect of forming tiny crystals within the tissue around the joints, causing swelling and pain, and causing the condition commonly known as gout.
These crystals in the joint area form at low temperatures this is why gout usually occurs in fingers or toes and could explain why some people appear to be more susceptible to gout than others. It is still unclear why some people still get gout, even when the urate levels are not very high, although research has shown that there are certain factors which will increase the likelihood of you developing this debilitating condition.
These include: if you are a man and aged between 40 and 50, you are a post-menopausal woman, you suffer from high blood pressure, or if you take certain medication.
Some people may suffer simply because it runs in the family or you have a history of kidney disease. Overweight people appear to be susceptible and also those that suffer from skin conditions such as psoriasis or have had an injury to a joint in the past.
How can you tell you have gout?
Gout can develop very quickly and sometimes in a matter of hours. You will notice a swelling and warmth around the joint accompanied by a red and shiny appearance. You may have a fever and find that you have developed white lumps under the skin.
After a consultation with your doctor he will send you for a series of tests which will typically include a blood test to assess the levels of urate in the system. He may order a fluid test which is when a sample is taken from the affected joint to check for urate crystals and less commonly, arrange for an X-ray of the joint to rule out other underlying medical conditions.
The attack will typically last for a couple of weeks and will eventually clear with little or no treatment. Treatment for the condition may reduce this period to under a week and will help to cut down on recurrent attacks.
The doctor may prescribe a non-steroidal anti-inflammatory drug to help relieve the inflammation or sometimes steroid injections may be used for the larger joints such as the knee. Steroid tablets may also be given if you show intolerance to certain prescriptive drugs.
Gout is a horrible condition and can be a truly agonizing experience for the sufferer. The diagnosis and methods of treatment and subsequent coping strategies will vary with one individual to another, and the general consensus with most patients, is that prevention is better than cure.
It is important to eat less sugar, and replace saturated fat with olive oil. Eat more fruit and vegetables (The World Health Organization recommends that we eat at least five portions each day) Cherries in particular, have been found to be beneficial for gout sufferers. It is also important to increase the intake of calcium- and iron-rich foods.
So, on the whole, gout is a condition that is best treated by being “managed”. This means that risk factors are identified and eliminated before an attack occurs. A sufferer may have to revise his eating habits and cut down on the intake of meat and fish. They will need to eat a well balanced diet and exercise sensibly. Alcohol can also trigger an attack. When my father in law suffers another bout of gout and he complains that he “only had just one glass of wine”.
“Was it really worth it?” I always ask him.
Gout. Bupa’s health information team, June 2008. http://hcd2.bupa.co.uk/fact_sheets/html/gout.html (accessed 10/10/08)
DietandArthritishttp://www.arc.org.uk/arthinfo/patpubs/6010/6010.asp (accessed 10/10/08)