What is gout and what causes it?
Gout is a type of arthritis, it causes attacks of painful inflammation in one or more joints. It is caused by a chemical in the blood, called uric acid (urate). Uric acid is usually harmless and is made in the body. In people with gout the amount of uric acid in the blood builds up. The crystals typically collect in a joint and causes inflammation of joint, which leads to acute attack of gout.
Why does uric acid build up?
Normally, there is a fine balance between the amount of uric acid that you make and the amount that you pass out in the urine and stools. This keeps the level of uric acid in the blood in normal range.
In some people, the build-up of uric acid may due to other factors – for example
l Drinking too much alcohol can cause uric acid to build up.
l If you drink sugar-sweetened soft drinks high in fructose it can cause uric acid to build up.
l Fructose containing fruit juices may also increase the risk.
l Eating a lot of red meat, herring, sardines, yeast extracts, or mussels may increase the level of uric acid.
l Some medicines may raise the level of uric acid – for example, ‘water’ tablets (diuretics) such as bendroflumethiazide, aspirin, and some chemotherapy medicines.
l People with certain other conditions have an increased risk of developing gout. These include:
a. Obesity.
b. High blood pressure.
c. Kidney damage.
d. Diabetes mellitus.
How common is gout and who develops it?
Gout affects about 1 in 100 adults. Men are more commonly affected than women. A first attack of gout typically develops in middle age but it sometimes occurs in younger people. It tends to run in some families, as there is a family history of gout in about 1 in 5 cases. It may be that the genetic makeup that you inherit from your family.
What are the symptoms of gout?
Gout usually occurs in attacks. An attack typically develops quickly over a few hours. It usually causes severe pain in one joint. The base of the big toe is the most commonly affected joint, However, any joint can be affected. Walking can be very painful and even the weight of bedclothes can hurt.
Is gout serious?
A gout attack can be very painful. Joint damage may occur if you have repeated attacks. In a few people, uric acid (urate) crystals form kidney stones or may cause some kidney damage.
How is gout diagnosed?
Gout is usually diagnosed if you have the typical gout symptoms and a raised blood level of uric acid (urate). If there is doubt as to the cause of the pain and swelling, your doctor may take some fluid out of a swollen joint.
What is the treatment for a gout attack?
A short course of an anti-inflammatory painkiller will quickly ease most gout attack. Your Rheumatologist doctor can select best medicine for your acute attack.
How can further gout attacks be prevented?
Lifestyle measures and medicines can help to prevent gout attacks
l If you are overweight, try to lose some weight. This can help to lower the uric acid (urate) level
l Avoid a high protein intake especially red meat (particularly beef, pork and lamb) and organ meat like liver, kidneys and seafood.
l Evidence suggests that plant foods aren’t associated with increased risk of gout.
l If you drink a lot of alcohol, then it may help if you reduce the amount you drink.
l Drinking plenty of water (up to two liters per day unless there is a medical reason to not do so)
Which foods are the best to eat?
Plenty of fruit and vegetables, Fruit and vegetables contain vitamin C. Although evidence is unclear, high intakes of vitamin C (500 mg or more) may help to reduce uric acid levels in the blood. Cherries may be particularly useful to include in the diet, as they have also been found to reduce levels of uric acid in the blood.
Low Fat dairy products (such as skimmed milk, low-fat yoghurt and low-fat cottage cheese) may help to prevent high levels of uric acid in the blood.
Some meat, fish, eggs, beans and pulses, can be use these foods in moderation.
Role of Rheumatologist in treatment of gout?
Treatment of gout can be difficult because of coexisting illnesses and other medications. As expert in treatment of arthritis, rheumatologist examine patients and educate them about diet and proper use of medications for treatment of gout.
Dr. Faisal Naseeb
Rheumatology Specialist
Bahrain Specialist Hospital
Email: faisal.naseeb@bsh.com.bh