Gout is a type of arthritis caused by uric acid crystals in joints which trigger inflammation. This can be very painful and debilitating.
Most of the time, gout is caused by difficulty getting rid of uric acid from the body and sometimes it can be because of too much production.
Uric acid is produced when DNA breaks down, which can happen when we consume too much meat, if we sustain burns, or following chemotherapy with the death of many cancer cells releasing DNA which is then turned into uric acid.
Some ethnic populations are at higher risk of gout including those of Polynesian background (Samoan, Tongan, Fijian to name a few) and this affects men and women from quite a young age and if left untreated can become very disabling.
The buildup of uric acid levels in the blood ‘spills’ over into the joints and forms urate crystals which can trigger inflammation.
You will notice inflammation in your joints. This can manifest with swelling, redness, heat and severe pain in your joints.
Gout typically affects places like your 1st toe, ankles, and knees but it can affect a number of joints in the body.
If gout is left untreated you may notice the development of white lumps that might ooze a chalky white substance. Theses lumps are known as ‘tophi’ and are collections of urate crystals and may hint towards a more serious problem of bony destruction.
Seek the assistance of a doctor such as your general practitioner or a rheumatologist who is a specialist in gout and arthritis.
There are two parts to the treatment of gout:
1) Treat gout flares – your specialist may prescribe medications or joint injections to settles acute flares of gout. Treatment is often short-term and only for as long as the flare is a problem for you. Some of the ‘flare’ medications your specialist may discuss with you include prednisone (Panafcort), colchicine (Lengout, Colgout), non-steroidal anti-inflammatory drugs (e.g. Indocid, Voltaren, Nurofen).
2) Prevent further flares – your specialist will discuss and prescribe medications to lower the uric acid level in your blood with the plan to ‘dissovle’ and get rid of gout crystals in your joints. These medications need to be taken regularly and consistently but stop working if you stop them. Some of the ‘preventer’ medications your specialist may discuss with you include allopurinol (Progout, Zyloprim), febuxostat (Adenuric) or benzbromarone.
It is very important to discuss with your specialist if you don’t understand any aspect of your treatment as your participation in therapy is critical to its success and helps avoid future problems.
Food with DNA rich content such as red meats and seafood are often implicated in the development of gout as they increase the production of uric acid in the body. However in the grand scheme of things it isn’t a major contributor to your risk of gout.
High production of uric acid is only implicated in ten per cent of cases and your diet only contributes to one third of the total uric acid your body produces – the rest is created by normal processes of cell breakdown in the body.
Therefore it is far more important to take your medications regularly to keep your gout under control.
In saying all the above, it is important to keep hydrated with water, reduce alcohol and sugary drink consumption (soft drink, fruit juices) as too little water and too much of these other fluids can trigger gout flares!
For one thing it is painful! Even if your attacks last for a short time and you recover quickly, repeated attacks of gout can lead to permanent damage to bone which can be irreversible.
Secondly gout in most cases is easily treatable with appropriate medication and careful monitoring. Treatment decisions should be discussed with a qualified specialist in gout and arthritis.
I’ve started my ‘preventer’ but I’ve had a flare of gout, what do I do?
First, DON’T STOP your preventer. It is commmon, particularly at the start of treating gout to have flares we think due to fluctuations in uric acid levels. Having a flare tells use the preventer is working.
Second, use your flare action plan if your specialist prescribed you one. If not, please make an appointment to see your specialist to obtain treatment for your gout flare.
Over time these flares should become less frequent as your preventer dose is increased to the appropriate level.
You will know when you are having a flare because it will be painful.
You may also notice the lumps or tophi on your body (commonly ears, elbows, toes) are reducing in size with treatment.
You will also be conducting and reviewing regular blood tests once a month at the beginning with your general practitioner or specialist as your ‘preventer’ medication dose is steadily increased. We aim for a particularly low level of uric acid in your blood to help get rid of urate crystals.