Gout

Gout is a common form of arthritis. Gout is caused by a build-up of a waste product, uric acid, in the bloodstream.

Uric acid is one of the body’s waste products. Normally it is dissolved in the bloodstream, filtered out by the kidneys and excreted in urine. However a build-up of uric acid may settle in the joints in the form of crystals, causing inflammation and pain. This is called gout.

Around 70,000 Australians have this form of arthritis. The joint of the big toe is usually the first site to experience an attack. The toe becomes red, swollen and extremely painful. Other joints commonly affected include the knee, ankle and those of the feet.

Most people with gout are male and the average age for the first attack is somewhere between 40 and 50 years. An inherited tendency to gout is the most common cause.

Sudden, intense pain
While most other types of arthritis develop slowly, an attack of gout happens suddenly, often overnight. Feet, ankles and knees are commonly affected, but gout can also be experienced in the elbow, hand and other joints. The pain can be so intense that even the weight of a bed sheet is intolerable.

Without treatment, an attack of gout can last around one week. It might be a long time before gout strikes again, perhaps even months, but without proper management, the attacks will become more frequent and can affect other joints. A joint might be permanently damaged by recurring attacks of gout, and may develop osteoarthritis. Uric acid can also lodge in surrounding tissue or, in some cases, form stones in the kidney or bladder.

High levels of uric acid
Some people have higher levels of uric acid in their blood than others. This condition is called hyperuricaemia. This can be hereditary. Other causes include fluid tablets (diuretics), which can interfere with kidney function and cause the retention of too much uric acid.

A person with gout is more likely to have an attack when they:

• Drink alcohol
• Eat too much
• Diet or fast
• Dehydrate – do not drink enough fluid
• Injure a joint.

• Non-steroidal anti-inflammatory drugs (NSAIDs) – such as indomethacin, to help control pain and swelling.
• Colchicine – a compound that has been used since around 500AD to successfully treat gout.
• Corticosteroids – may be used to reduce pain and swelling during an acute episode.

• Maintain a healthy weight
• Limit wine, beer and other alcohol
• Drink plenty of non-alcoholic fluids, especially water
• Exercise regularly
• Treat high blood pressure
• Cut down or eliminate certain foods from the diet, such as liver, anchovies, shellfish and meat extracts
• Protect painful joints in bed. During a painful episode a ‘cage’ or bed cradle to lift the weight of bedclothes off the feet may be helpful.

• Your doctor

• Gout is a type of arthritis caused by too much uric acid in the bloodstream.
• Excess uric acid settles in joints and causes pain and swelling.
• Healthy lifestyle choices combined with a correct treatment program should mean that gout can be successfully managed.

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