Gout

What is Gout

Gout, a form of inflammatory arthritis, is marked by elevated levels of uric acid in the bloodstream.

This acid, a byproduct of purine metabolism found in some foods, has limited solubility in water. Overproduction of uric acid or insufficient elimination by the kidneys can result in its crystallisation within joints, causing the inflammation characteristic of gout.

Gout commonly affects the big toe joint but can impact any joint, such as the ankles, knees, elbows, wrists, and fingers.

Symptoms

Gout presents with various symptoms that often manifest suddenly.

• Swelling: Swelling in the affected joint is common, often causing noticeable discomfort.
• Pain: Intense pain may be experienced in the affected joint. It may be exacerbated with weight-bearing or pressure.
• Skin Changes: The skin around the affected joint may show bruising or colour changes.
• Deformity: In more serious cases, the affected joint may become deformed, appearing crooked or misshapen.
• Audible Popping or Snapping: An audible popping or snapping sound may be heard at the time of injury.
• Limited Movement: The joint’s range of motion might be limited, affecting normal movement.

Causes and Risk Factors

Gout is primarily caused by hyperuricemia, a condition where the body contains excessive uric acid. This excess can lead to the formation of monosodium urate crystals in joints, fluids, and tissues, resulting in the characteristic inflammation, pain, and possible deformity associated with gout. Factors influencing the development of hyperuricemia include:

• Diet
  The consumption of foods high in purines, such as red meat, organ meats, and certain seafood, can increase uric acid levels. Alcoholic beverages and drinks sweetened with fruit sugar (fructose) also contribute to higher uric acid levels.
• Obesity
  Being overweight can lead to increased uric acid production and reduced elimination by the kidneys.
• Certain Medical Conditions
  Certain health conditions, including high blood pressure, diabetes, metabolic syndrome, and poor kidney function, are linked to a higher risk of gout.
• Certain Medications
  Some medications, like diuretics and those used for hypertension, may affect uric acid levels.
• Middle-Aged Men and Women After Menopause
  Gout is more common in men, particularly between the ages of 30 and 50. Women’s risk increases after menopause.
• Genetic Predisposition
  A family history of gout may predispose individuals to the condition.

Treatment Options

The management of gout includes various medications and lifestyle adjustments, focusing on alleviating pain, preventing future episodes, and controlling uric acid levels.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

These medications, such as ibuprofen and naproxen, are used to relieve pain and inflammation associated with gout attacks. Prescription NSAIDs may be recommended for more severe cases.

Colchicine

This medication is specifically used for gout treatment. It is an anti-inflammatory agent that reduces gout pain. Colchicine should be used with caution, as it can cause side effects including nausea, vomiting, and diarrhoea.

Healthy Diet

Adapting a diet low in purine-rich foods like red meat and certain seafood, and avoiding drinks sweetened with fructose or high in alcohol, can help manage gout and lower the risk of gout flare-ups.

Weight Management

Maintaining a healthy weight through regular exercise and weight loss can help manage gout. Being overweight can increase uric acid production and decrease its elimination by the kidneys. A gout specialist may suggest engaging in several low-impact exercises, such as walking and swimming, to help manage the condition.

Prevention Strategies

Certain strategies can be implemented to reduce the likelihood of developing gout.

• Dietary Adjustments to Lower Uric Acid Levels: Reducing intake of purine-rich foods like red meats and certain seafood, along with limiting alcoholic beverages and drinks high in fructose, can help lower uric acid levels and prevent gout flares.
• Maintaining a Healthy Weight: Achieving and maintaining a healthy weight reduces the risk of gout. Excess weight can lead to increased production and decreased elimination of uric acid.
• Adequate Hydration: Drinking plenty of water aids in flushing out uric acid from the body. This helps reduce the risk of crystal formation in the joints.
• Adhering to Prescribed Medication to Control Uric Acid Levels: For individuals with a history of gout or elevated uric acid levels, adhering to prescribed medications that control uric acid levels can help prevent gout attacks.
• Regular Exercise: Engaging in regular, low-impact physical activities helps in weight management and maintains joint flexibility, both of which are beneficial in reducing the risk of gout.