Gout

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Historically, gout was known as "The Disease Of Kings" or "Rich Man's Disease".

Gout is a condition of abnormal uric acid metabolism. The body either produces too much uric acid, or has a problem removing it. The resulting high uric acid levels cause uric acid crystals to deposit into tissues typically around the joints. These crystals cause the severe acute tissue inflammation which is characteristic of gout.

SYMPTOMS

Gouty arthritis affects mainly the small joints such as the toes, ankle and the small joints of the hands. Attacks tend to be recurrent, but the first attack is usually in the big toe (in about 75%).

In an acute attack, there is sudden extreme pain in the affected joint (usually only 1 joint), which becomes red, hot and swollen. Movement and even the slightest touch causes severe pain.

Over time, these uric acid crystals can form uric acid kidney stones. They can also form outside the joint, resulting in lumps under the skin, called tophi. Common sites of these painless tophi are the ear lobes, elbows and back of the ankle.

CAUSES

Uric acid is a waste product produced during the metabolic breakdown of purines. Purines are part of all our body's cells and is also found in many of the foods we eat.

So, if you body produces too much uric acid (eg. Chemotherapy and radiotherapy causes increased tissue breakdown) or you eat too much of foods that are rich in purines (see below), and your kidneys cannot eliminate it fast enough, uric acid will build up in the blood.

RISK FACTORS

• Genetics – 20% have a family history of gout.

• Occurs more commonly in males.

• Onset earlier in men (40-50 years) than women (>60 years)

• Being overweight increases risk of developing gout

• Medical problems which may contribute to hyperuricaemia (eg. renal insufficiency, high blood pressure, hypothyroidism, psoriasis, polycythaemia, diabetes)

• Diet – alcohol, red meats, beans and bean products, prawns, crabs, scallop, lobster, innards

GOUT - MANAGEMENT

Management objectives include symptomatic treatment as well as preventing further attacks.

Symptomatic treatment:

• Application of ice over the inflammed joint for 20-30 min several times a day.

• Non-steroidal anti-inflammatory drugs (NSAIDS) such as mefenamic acid, diclofenac, voltaren and indocid.

• Colchicine

• Steroids are very powerful anti-inflammatory agents. However, great care must be exercised when using steroid, as a septic joint (sometimes confused with gout) will be made much worse if steroids are taken.

Prevention:

• Dietary and lifestyle changes can significantly reduce the risk of acute attacks.

• Allopurinol effectively blocks uric acid production, and can be taken to reduce uric acid levels. You should discuss with your doctor if your condition warrants taking allopurinol. Severe hypersensitivity reactions occur in a small number of patients who take allopurinol.