Gout

Gout is a common type of arthritis that causes intense pain, swelling and stiffness in a joint. It usually affects the joint in the big toe. Symptoms can flare-up in the middle of the night, with the big toe swollen and very uncomfortable. Gout is caused by accumulation of urate crystals in the joints.

Gout can be treated with medicines that relieve pain and reduce crystal formation between joints. Long term disabilities can include damage to the affected joint and worsening pain.

Gout flare-ups almost always occur suddenly and may wake and keep you up at night. They include:

• Intense pain usually affects the large joint of your big toe, but it can occur in any joint as well, including the ankles, knees, elbows, wrists and fingers.
• The affected joint or joints become swollen, tender, warm and red.
• Joint discomfort may last several days to weeks after the swelling and tenderness subside.
• Damaged joints can lead to a limited range of motion as the disease progresses.

Gout is caused by a build-up of urate crystals in your joints. The crystals cause swelling, injury and pain (called a gout flare-up). The urate crystals are produced when your body breaks down substances found naturally in your body (purines), from some foods (like red meat and sardines), alcohol and fruit sugar.

If your body produces too much uric acid or removes too little of it from your blood, this can build up and increase flare-ups.

• Middle-age men or a women experiencing menopause are at increased risk for gout.
• Having parents, siblings or other family members with gout.
• If your kidneys do not flush out uric acid as much as it is produced inside you.
• If you eat too much food, such as red meats, organ meats (nkan inu/ kayan ciki) and shellfish.
• Drinking alcohol.
• Taking medications such as water pills (diuretics).
• Having a condition such as high blood pressure, kidney disease or diabetes.

If you experience sudden, intense pain in a joint, call your doctor. Gout that goes untreated can lead to worsening pain and joint damage.

Seek medical care immediately if you have a fever and a joint is hot and swollen, which can be a sign of infection.

You can prevent gout flare-ups by self-care and through prescription medications. Self-care can include choosing water (other than beverages), avoiding foods containing purines, choosing low-fat dairy products as protein-source, keeping physically active and maintaining a healthy weight. Medicines that prevent gout flare-ups either block uric acid production (like allopurinol) or improve how your body removes uric acid (like probenecid).

Self-care:

• Reduce your alcohol intake.
• Lose weight.
• Stop smoking.
• Eat a diet that is rich in vegetables and avoid shellfish, lamb, beef, pork and organ meat.
• Stop smoking.
• Exercise, except during a painful gout flare-up.
• Stay hydrated.

Treatment:

Relievers to treat pain and inflammation

• Pain relievers like ibuprofen, diclofenac and celecoxib are used to relieve pain and discomfort. They may also reduce swelling. Some of these medicines are over-the-counter, and others (e.g. Celecoxib) are prescription-only.
• Colchicine is a prescription-only medicine that reduces pain and swelling as well. Diarrhoea and vomiting may limit its use.
• Corticosteroids are prescription-only medicines that are important in resolving inflammation. They can be injected into the joint to reduce side effects.

Preventers to block uric acid production or remove the uric acid from your blood

• Your healthcare provider may recommend preventers (e.g. allopurinol) that reduce how much uric acid your body makes. They may also recommend medicines (e.g. probenecid) that improve how well your kidneys remove uric acid.
• These are all prescription-only medicines, and the dose is gradually increased to the highest you can tolerate with the fewest side effects.

If left untreated gout can lead to arthritis. Your healthcare provider can prescribe drugs to treat gout, but will also advise on lifestyle changes to reduce the production of uric acid by your body. Medical treatment and self-care are important to reduce discomfort. How well you follow these recommendations will determine how well your condition improves. The complications of gout are severely limiting; early diagnosis and treatment are important for getting better and avoiding joint damages.

Most people with gout will have recurring episodes of flare-ups. With continued adherence to the advice of your healthcare provider and self-care, severity reduces and complications are avoided.