As a rheumatologist, one of my areas of expertise and interests is gout. It is a common problem and can cause real misery and pain. People are often referred to me to help with the diagnosis of gout and also to treat it. To understand this, we need to understand what it is, how we diagnose it and what both patients and doctors can do.
What is gout and what are the symptoms?
Gout is a result of build-up in the joint of a type of crystal called “uric acid”. Uric acid comes from the breakdown of protein. Gout typically affects the big toe (an attack of gout in this area is called “podagra”), but can affect any joint. It is usually extremely painful, and comes on very quickly. Initially, the attacks may go after a few days/weeks, but may be more prolonged if left untreated.
Who gets gout?
Gout is VERY common and one study has shown it affects about 2.5% of people in the UK. That is over 1 million people! One common misconception is that gout is a “rich man’s” disease. This could stem from the fact that famous people in the past to get gout included King Henry VIII and King Louis XVIII of France. However, gout can affect men and women (most commonly post-menopausal).
Why do I get gout?
Gout is a result of too much uric acid in the body. Diet may play a role in the build up of uric acid and certain foods and drinks such as red meat, alcohol and shellfish may cause symptoms. However, there may be a genetic element also, as people who cut all potential triggers from their diet can still get gout attacks.
Is getting gout a problem?
Gout is very painful and when you get an attack it can be disabling! A commonly unknown fact about gout is that it is associated with other conditions, such as high blood pressure, diabetes, heart/kidney problems and high cholesterol. Treating gout may also help with these conditions.
How do you diagnose gout?
Gout is diagnosed from the story, and blood tests and X-rays can be helpful. Sometimes, a sample of fluid from the painful joint can show gout crystals when looked at under the microscope.
What can I do to treat my gout?
You should have a chat with your doctor when you have your first gout attack and before you try any treatments. There is some evidence to suggest that vitamin C and cherry can help reduce uric acid (note: juices such as orange juice which contains vitamin C but also fructose sugars may trigger gout). Non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen can also help, although some people cannot take this due to other health problems, such as kidney problems or asthma.
What else can I do?
If you have attacks of gout, you should see your doctor. They can prescribe you medications to help lower the uric acid in your blood. This in turn will reduce your gout attacks. Common medications used to treat gout include allopurinol or febuxostat. In difficult to treat cases, or when the diagnosis is not certain, rheumatologists such as myself are involved.
