In this weeks Topic, Eamonn discusses Gout, an extremely painful condition that is on the rise......timely with the "over indulgence" season just in view

Gout

Gout is an inflammatory condition more common in men; especially men aged 40 to 60. The most common site for an attack of gout is the joint at the base of the big toe

Why it happens?

Gout is a condition that occurs when uric acid levels build up in joints. Uric acid is a waste product in your blood that is removed by the kidneys and eliminated in urine. The body's overproduction of uric acid or the kidney's inability to eliminate it efficiently can cause an excessive build-up. Over time this excess uric acid can deposit in the joints where it forms into sharp, uric acid crystals that lead to extreme pain and swelling in the affected joint.

What causes it?

Attacks of gout often occur after indulging in alcohol, particularly wine or beer, or after overeating rich foods such as liver, anchovies, and gravy. Gout tends to run in families. Therefore, some people are genetically prone to gout and may develop gout even if they eat very little purine rich food. Some medical conditions can make you prone to gout including reduced kidney function. This is because if the kidneys are not functioning properly they will not be able to excrete excess uric acid. Some drugs such as thiazide diuretics (used for high blood pressure eg. Bendrofluazide) and low dose aspirin (used to thin blood) can cause gout as they reduce uric acid excretion.

What are the symptoms?

The first symptom of gout is usually extreme pain in the big toe. The joint at the base of the big toe becomes swollen and the overlying skin becomes shiny and purple. The toe becomes very tender and sufferers find that they are unable to wear a shoe on the affected foot or even tolerate the weight of bed sheets at night.

The first attack of gout will usually subside after about a week and about 10% of people will never again experience gout. The remainder may experience attacks with increasing frequency and each subsequent attack can be of longer duration. Repeated attacks of gout over several years can cause arthritic damage to the joint. While gout most often affects the big toe, it can also attack other joints. The knee can sometimes be affected.

If gout is left untreated, urate crystals will eventually collect under the surface of the skin and will cause small bumps near the joints, or more commonly on the outer side of the ear. These bumps are known as tophi and occasionally they rupture and discharge a yellowish, chalky material.

Complications of Gout

About 20% of those with gout also suffer from kidney stones. Small stones may cause no symptoms, but larger stones can interfere with kidney function. Symptoms of kidney stones include intense intermittent pain in the side and abdomen, nausea, vomiting, a distended abdomen, chills, fever, and blood in the urine. Smaller stones require no treatment and drinking plenty of water may help flush them out of the kidney in the urine. Larger stones must be broken up by ultrasound waves or be surgically removed. Drinking plenty of water (8 glasses per day) can reduce the risk of kidney stone formation in patients with gout.

How is it diagnosed?

Gout is usually diagnosed based on the history of the attack and the physical signs. To rule out other rheumatic conditions, your GP will probably take a blood sample to measure the concentration of uric acid in the bloodstream.

How is it treated?

Gout is usually treated with non-steroidal anti-inflammatory drugs such as ibuprofen (Nurofen^®) or diclofenic (Difene^® or Diclac^®). Painkillers that lack anti-inflammatory activity such as paracetamol will not give adequate relief. With proper treatment a gout attack will begin to subside within a few hours and go away within a few days. Untreated attacks may last days or weeks. Once the inflammation has disappeared the medication can be discontinued. Colchicine is a prescription medication medicine which may be used to treat gout if the patient cannot tolerate anti-inflammatory medication. It is only used for short term use and may cause some gastrointestinal upset if used in higher doses. Rarely, in severe cases, a doctor may prescribe oral steroids or give steroid injections into the affected joint if the inflammation is not responding to other anti-inflammatory medication.

Preventative medication

If a person suffers from frequent recurrences of gout, they may need long term medication in order to keep the levels of uric acid within normal limits. Allopurinol is the most common medication used for the prevention of gout. It works by reducing uric acid production in the body. Side effects may include nausea, vomiting, headaches and rash, but these are rare. The doctor will only start allopurinol if you have suffered several bouts of gout and blood tests show high uric acid levels. Allopurinol should not be started within 4 weeks of an attack of gout and once started it takes up to 3 weeks before its effect is maximised. Allopurinol is often required for life as people find when they stop preventative therapy, gout re-occurs. Febuxostat is a newer preventative medication for gout that also works by reducing uric acid levels; it is generally only used if someone cannot tolerate allopurinol.

Prevention

Reduce the amount of meat in your diet because meat is rich in uric acid forming components. Consider a vegetarian lifestyle. Eat plenty of raw fruit, vegetables, grains, seeds, and nuts. Cherries and strawberries appear to be most beneficial. Avoid purine rich foods like anchovies, asparagus, crab, caviar, herring, kidney, liver, meat gravies and broths, mushrooms, mussels, peas, beans, and sardines. Maintaining a low-fat diet and losing weight if you are overweight will help. Regular exercise and low alcohol consumption will aid prevention. Drinking plenty of water helps to wash uric acid out of the urinary system.

Disclaimer: Please ensure you consult with your healthcare professional before making any changes recommended

For comprehensive and free health advice and information call in to Whelehans Pharmacies, log on to www.whelehans.ie or dial 04493 34591 (Pearse St) or 04493 10266 (Clonmore).