Gout is caused by an excessive build up of uric acid in the body. This could be the result of kidneys being unable to excrete sufficient amounts or the body producing uric acid in excessive amounts. High levels of uric acid in the blood is termed Hyperuricemia. This can in some instances be a precursor of gout. However, a significant number of people may have hyperuricemia but never go on to develop gout. This condition is known as asymptomatic hyperuricemia. On the other hand, counter-intuitively, some gout sufferers when tested are found to have low levels of uric acid in the bloodstream. Consequently, blood tests for uric acid are not a reliable basis for a diagnosis of gout.
An attack of gout occurs when uric acid crystallizes and these crystals are deposited in the joints causing painful arthritic inflammation of the joint. The most common joint affected is the base of the big toe, followed by ankles and knees. Gout usually affects only one joint at a time. The most reliable basis for diagnosis of gout is by aspirating fluid from the affected joint using a needle and examining it for uric acid crystals. Onset of gout can be sudden and the affected joint may be extremely painful, almost unbearable to touch and could become red and swollen. If left untreated and in the absence of exacerbating factors an attack would usually clear up within a week or two. However, medication can help significantly reduce the duration and intensity of the attack.
Several factors increase susceptibility to gout including:
Genetic factors – Gout tends to run in families but some family members may simply have hyperuricemia while others go on to develop full blown gout. There is currently no explanation for the different responses in different individuals in these circumstances.
Men are far more prone to gout than women. In fact gout is rare in pre-menopausal women and attacks in younger women may warrant special attention as it could indicate the presence of a more serious underlying problem.
Dehydration – inadequate fluid intake makes it harder for the kidneys to excrete uric acid that builds up in the body. Some medications which have a diuretic effect can also trigger gout for similar reasons.
Being overweight significantly increases the risk of gout.
Diet plays an important role. Consumption of foods high in purine – notably red meats contribute to gout since uric acid is the final output of the metabolism of purine. Yeast also increases uric acid levels
Excessive alcohol consumption can increase the likelihood of gout in two ways. Alcohol and yeast from beer tend to increase the production of uric acid in the body. Alcohol also acts as a diuretic thus making it harder for the kidneys to get rid of the increased uric acid.
High blood pressure or abnormal kidney function are also risk factors for gout.
Excessive fructose consumption usually from sweetened drinks is also known to contribute to gout.
Trauma to the joint or recent surgery which can affect fluid balance in the body may also trigger gout.
Gout can be prevented by adopting some or all of the following measures:
Increase water intake to help the kidneys get rid of more uric acid.
Lose weight gradually and sensibly. Sudden weight loss is not a good idea as this can actually increase uric acid levels in the blood. Weight loss should be combined with a suitable exercise regime for best results.
Limit alcohol intake.
Change diet to exclude purine rich foods such as red meat, offal and seafood. Reduce or eliminate fructose intake.
Keep blood pressure under control and exercise appropriately.
Treatments for gout include:
- Resting the affected joint and application of ice packs
- Pain medication
- Non-steroidal anti-inflammatory drugs to help reduce inflammation.
Steroids may also be prescribed or injected directly into the joint to control inflammation.
If the patient suffers recurring attacks medication may be prescribed to reduce uric acid levels in the blood.
If the underlying causes of gout are left untreated it can develop into something far more serious than a painful joint. Further build up of uric acid can deposit itself in other tissues for instance leading to kidney stones and even kidney failure. It is therefore best to bring it under control as soon as possible.
