Gout

Gout,

the word conjures up feelings of excruciating pain tender to the touch especially in the big toe, ankles and sometimes the knees as well and images of angry, reddened, swollen joints. Uric acid is a waste product of purine metabolism in the liver.

Gout is a disorder caused by the overproduction by the liver and under secretion by the kidneys of uric acid.

Cold and outer extremities

Gout comes from the formation of uric acid crystals in the joint spaces. The spiky, needle shaped crystals of monosodium urate are inert but are recognised as foreign by the immune system. It is then attacked by white blood cells but that only succeeds in causing pain and inflammation in the surrounding area where the crystals formed.

Uric acid tends to crystallise in the toes, feet and knees, sometimes in the wrists and fingers as the body temperature is cooler in the lower extremities.

Triggers and Prevention

It is unclear what the triggers the uric acid to crystallise, it can happen even at normal blood levels and the likelihood increases as the blood uric acid levels go higher.

For some people, cold weather can trigger an attack of acute gout.

Other people may have eaten a meal containing purine rich foods such as red meats or organ meats and then suffer an attack.

Beer drinkers may also suffer from gout attacks as the proteins and alcohol also increases the production of uric acid leading to rapid changes in their blood uric acid levels.

Preventative steps taken to avoid or reduce acute gout attacks will depend on the individual's triggers. In general, dietary changes can be made to reduce the consumption of purine rich foods like red meat, seafood, certain vegetables, beans and alcohol. Keeping the legs and feet warm at night by wearing long pants or even socks may also prevent gout.

Pain Relief

The aim is to reduce the pain of the acute gout attack and to achieve long term control of gout by reducing the overproduction of uric acid or by increasing the elimination of uric acid in urine.

In the event of an acute gout attack, the joint pain begins over 2-4 hours or usually at night when it is cooler.

Use an ice pack to cool the pain and swelling of an acute gout attack, frequently over the course of the day.

NSAIDs work rapidly to both relieve pain and decrease inflammation, their use is limited by the risk of gastrointestinal ulceration, renal failure and heart failure.

Colcichine, is an alternative to NSAIDs though its use is limited by the side effect of diarrhoea.

When gout attacks become more frequent, with the appearance of uric acid deposits called tophi and signs of gouty arthritis together may need long term treatment.

To control gout and prevent further gout attacks, treatment would either focus on reducing the formation of uric acid from purines using allopurinol or increasing the excretion of uric acid with urine.

These treatments would need to be taken as life long treatments and from time to time blood tests needs to be done to check on the uric acid level. 

Anyone who feels they may be suffering from gout, should seek advice from their pharmacist or see their family doctor.