What it's really like to live with gout
What causes gout?
Gout is a kind of arthritis - which is an inflammatory condition - but it’s very different from the more common osteoarthritis or rheumatoid arthritis. It usually causes short-lived bouts of severe pain and tends to affect only one, or a few joints
I remember when I was a girl watching films about larger characters like King Henry VIII hobbling around, clearly afflicted by gout because he’d overdone it on the port and general excess living. King Henry's weight probably caused his gout as much as the wine.
Gout is caused by a build-up of a chemical called uric acid. Normally, our bodies get rid of uric acid through our kidneys at about the same rate it’s made. But some people don’t remove it very efficiently, and some lifestyle factors can lead to it building up.
Too much cholesterol in your blood leads to fatty deposits forming on the inside of your arteries. With too much uric acid in the blood, the excess can form tiny crystals in your joints. This results in irritation that in turn leads to redness, swelling and pain, with tenderness so painful some people can’t even wear socks as it hurts so much.
Sometimes gout can be triggered by medicines used to treat high blood pressure - speak to your pharmacist if you are worried.
The main signs and symptoms of gout include:
- Severe pain in one or more joints.
- The joint feeling hot and very tender.
- Swelling in and around the affected joint.
- Red, shiny skin over the affected joint.
What happens during a gout attack?
The joint at the base of your big toe is most commonly affected, although it can affect other joints and occasionally leads to hard deposits under your skin. Most attacks settle on their own within a week or two. Some people only get one attack in a lifetime, but usually people get bouts every so often.
How is gout usually treated?
Sudden attacks of gout are usually treated with anti-inflammatory tablets. Drugs such as diclofenac and indomethacin aren’t used much anymore, because of the risks of heart attack they carry in the long term. But if alternatives like naproxen don’t work, your doctor may recommend them for a few days. The treatment should ease your symptoms within a few hours.
Taking these medicines, especially for long periods, can cause inflammation of, or bleeding from, your stomach. Always speak to your doctor about taking them. Your doctor may recommend taking a ‘stomach protector’ medicine while you’re taking them.
If you’re getting two or more attacks a year, your doctor may recommend regular medicine to ease the symptoms. The most common is called allopurinol - the dose can vary from 100mg to 300mg a day, and it works by reducing the uric acid in your blood.
Your doctor will do blood tests to monitor your uric acid levels on treatment. You shouldn’t start it until around 4 weeks after any attack of gout settles, as it may make matters worse in the short term. If allopurinol doesn’t work, or you can’t take it, there are other alternatives which your doctor can talk to you about.
Who is prone to getting gout?
According to the UK Gout Society around 1 in 14 men and around 1 in 35 women get gout. Men will usually get gout in middle age - but can get it any time after puberty. In women it is uncommon before the menopause.
It can run in families, possibly because you inherit a tendency to clear uric acid less efficiently through your kidneys. But your diet and weight can also play a part.
If you have any of these issues you are more likely to get gout:
How to avoid an attack
Changing your diet can cut your risk of future attacks of gout. Generally following a healthy diet will help, but to avoid gout you should avoid foods containing a natural chemical called purine, which is broken down into uric acid. Here are some of the things you can do with your diet to help prevent gout:
- Limit red meat and poultry - it is often high in purine. Foods to avoid include - sardines, herring, mackerel, trout, whitebait, anchovies, prawns, crab, liver, kidneys, stock cubes and marmite.
- Protein. To keep your protein intake up without increasing your purine intake, eat more low fat dairy products, eggs, tofu, nuts, beans and pulses
- Limit alcohol. Beer is a particular issue for those with gout, but spirits increase your risk too, and so does drinking a lot of wine.
- Keep hydrated. Drink plenty of fluids as dehydration can bring on gout.
- Avoid sugary sweetened drinks. Also any food or drink containing ‘high fructose corn syrup.
- Eat plenty of fruit and veg. As well as being healthy, some research has suggested that lots of vitamin-C can protect against gout. Cherries are delicious and healthy - and if you’re a gout sufferer, eating them regularly can help keep attacks at bay1.
- Lose weight safely. If you’re overweight, see your nurse or doctor about a slow, steady weight loss regime. Losing weight will cut your risk of gout, but crash diets and high protein fad diets like the Atkins diet can increase your uric acid levels.
With thanks to ‘My Weekly’ magazine where this article was originally published.