Gout is this week’s medical condition of the week. Gout is a metabolic disorder in which uric acid crystals are produced by the body and form inside joints. The condition affects approximately 1 in 70-100 people in the UK, being more prevalent in men than women, leading it to be the most common cause of inflammatory joint disease in men over 40. Most commonly the condition first appears as a sudden severe pain in the joint, with the big toe being the first joint affected in over 50% of cases. In most cases gout will continue to only effect one joint, however in up to 10% of cases it affects more than one joint, including the food, knew, ankle, hand, elbow and wrist.
The symptoms of gout often develop at night, and often develop rapidly to their worst point in 6-24 hours and usually last for 3-10 days, known as a gout attack. During this time symptoms can include swelling and inflammation in and around the affected joint; red, shiny skin over the affected joint; peeling, itchy and flaky skin over the affected joint as the inflammation subsides. However after a gout attacks any pain or discomfort usually disappears completely and the joint will begin to feel “normal” again. The amount of time between gout attacks varies from person to person, approximately 62% of people experience a repeat attack within a year, however some will only experience a couple of attacks in their lifetime.
If gout reoccurs over many years it may lead to further symptoms. This can include the development of tophi, firm, white lumps beneath the skin which are made up or uric acid crystals, which can sometimes become inflamed and cause discomfort.
Gout itself is caused by a build-up of uric acid in the blood. Uric acid is normally found in low levels in the blood, as it is a waste product of the breakdown on chemicals in cells called purines, and is normally excreted by the kidneys. However, the saturation of uric acid in tissues by too much production of uric acid of excretion of too little uric acid during urination causes crystals of urate to form in and around the joints causing the symptoms of gout.
It was often thought in the past that this risk of gout was greatly increased by eating a diet rich in purines, giving it the association of being a rich man’s disease. However, recent research in New Zealand, had discovered instances of gout in the indigenous Maori population in pre-European times. As the Maori did not live a lifestyle of luxurious as their European counterparts the discovery has caused scientists to look more towards a genetic link in the development of the condition. However, this is still being investigated.
However it is still known that there are certain factors which may increase the risk of developing gout. This includes age, gender, obesity, high blood pressure and long term kidney problems. It has also been investigated that alcoholic drink, in particular beers and spirits can raise the level of uric acid in the body by increasing its production in the liver, and decreasing the level or urination.
When treating gout there are two main goals in consider; relieving symptoms during a gout attack and preventing further gout attacks. Relieving symptoms of a gout attacks is often treated using a type of pain killer known as non-steroidal anti-inflammatory drugs or NSAIDs. It is also thought that self-help techniques such as resting and elevating the affected limb can help reduce pain. Also applying an ice pack to the affected joint for approximately 20 minutes can cool the joint and help to alleviate pain. It is also possible to take corticosteroids to treat severe cases of gout if not other treatment has been successful.
Preventing future attacks can be done though both medication and lifestyle changes. The main medications used are known as urate-lowering therapy of ULT, which help to lower the levels of uric acid to below the levels requires for crystals to form, known as the saturation point. This included medication such as allopurinol and febuxostat which inhibit the enzyme xanthine oxidase responsible for converting purines into uric acid.
Lifestyle changes can include avoiding eating food which contain a large amount of purines such as some meats including kidney, liver, veal, turkey and venison, and sea-food. It is also often thought that being overweight can contribute to the development of gout, so sometimes eating a more calorie-controlled diet can help to control gout attacks. It is also important to when possible avoid potential environmental trigger factors of gout, such as alcohol, drugs, crash-dieting, injury and illness and prolonged stress.
However, gout can often be controlled well and complication of the condition such as kidney stones and tophus formation are uncommon. Like with any chronic illness gout had to be well controlled and often involved major lifestyle changes, however, it is also relatively easy to diagnoses and control, with many people having long periods of time between gout attacks.
Sources:
UK Gout Society ‘All About Gout’ patient information booklet (revised 2009) can be found at: http://www.ukgoutsociety.org/docs/2009FinalGoutBooklet.pdf
http://news.xinhuanet.com/english/health/2013-10/21/c_132817182.htm
http://www.bupa.co.uk/individuals/health-information/directory/g/gout
http://www.nhs.uk/Conditions/Gout/Pages/Treatment.aspx
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