Gout

You can develop gout if you have too much uric acid in your body. Uric acid is a chemical that everyone has in their blood. It's a waste product formed from substances called purines, which are found in every cell in your body and certain foods. Uric acid is formed in your body when the purines in foods you eat are broken down. It's also formed when old cells in your body are broken down and replaced by new cells. Excess uric acid is passed through your kidneys and out of your body in your urine. However, the level of uric acid in your blood can rise if:

• your kidneys don't pass uric acid quickly enough
• your body produces too much uric acid

If the level of uric acid in your body is too high, it can form tiny crystals that collect in your tissues, particularly in and around your joints. This is what may cause your swelling and pain. These crystals tend to form at a cooler body temperature, which is why gout is more common in your fingers and toes.

You may have high levels of uric acid, but not get gout, or you may get gout, but not have high levels of uric acid. It's not known why some people develop gout and others don't. However, there are certain factors that can increase your likelihood of getting gout. You're more likely to get gout if you:

• are a man aged 30 to 60
• are a woman who has been through the menopause
• eat a diet that contains high levels of purines, which are found in red meat, seafood and some other foods
• drink too much alcohol, especially beer
• don't drink enough fluids daily and become dehydrated
• take certain medicines, such as diuretics (water tablets), which increase the flow of urine from your body
• have a family history of gout
• have kidney disease meaning that your kidneys don't pass enough uric acid out in your urine
• are overweight, have diabetes or high blood pressure
• have psoriasis (itchy, dry and flaky skin), which can sometimes cause your body to produce too much uric acid
• are taking certain types of cancer medicines

You may only ever have gout once in your life and it may go away without any treatment.

The first symptoms of gout in your affected joint include:

• severe pain
• swelling and warmth around the area
• red and shiny skin around the area, which may peel later on

You may also have a mild fever.

If you have gout that reoccurs over many years, you may have further symptoms. This can include firm, white lumps developing beneath your skin – these are made of uric acid crystals and are called tophi. Tophi usually take up to 10 years to develop from your first episode of gout. Having tophi can lead to a range of problems, including:

• the tophi becoming inflamed, which can cause discomfort
• tophi breaking down and leaking out a white, paste-like substance

You may want to discuss with your doctor treatments to ease discomfort from having tophi. However, taking antibiotics for inflamed or leaking tophi won't help because tophi aren't caused by bacteria.

These symptoms may be caused by problems other than gout. If you have any of these symptoms, see your doctor for advice.

Having gout won't always lead to further problems, but you can reduce your risk of having complications by having treatment and making changes to your lifestyle and diet.

The most common complication of gout is progressive joint damage, which leads to long-term pain, deformed joints and eventually, disability. This may be prevented by changes to your diet and by taking medicines that lower your uric acid levels. There is also some evidence that prolonged high levels of uric acid in your body can increase your risk of vascular diseases, which may lead to a heart attack or stroke.

Other complications that you may have are as follows.

• Gout affecting several of your joints (called polyarticular gout). This happens more often in older people with gout.
• Getting kidney stones (if uric acid crystals collect in your urinary tract). This happens to between one and three in 10 people who have gout.
• Damage to your kidneys (if uric acid crystals collect in your kidney tissue).

Your doctor will ask about your symptoms and examine you. He or she will also ask you about your medical history and that of your family. Your doctor will usually take a sample of your blood, which will be sent to a laboratory to measure the levels of uric acid. Your blood sample may also be tested to find out whether there may be another reason for your symptoms.

Your doctor may refer you to a rheumatologist (a doctor specialising in conditions that affect the joints) for further tests.

Your doctor may remove some fluid from your swollen joint with a needle. This usually causes no more discomfort than a blood test. If uric acid crystals can be seen in the fluid under a microscope, you have gout. If calcium crystals are seen, you have a similar condition called pseudogout. The crystals formed when you have pseudogout are made of a calcium salt called calcium pyrophosphate. You may need to have an X-ray of your joint in order to rule out other conditions and to find out if any damage has occurred, but this isn't used to diagnose gout.

You will usually have symptoms of gout for up to two weeks and then they will go away, even without treatment. You may only have one episode of gout in your lifetime, but it might return. If you have no treatment to prevent gout, the risk of it returning within three years is over eight in 10. If you don't have treatment, having gout may become more frequent and last for longer.

Self-help
There are a number of steps you can take to reduce the pain and swelling from having gout.

• Raise and rest your joint. Don't do any vigorous physical activity. Rarely, your doctor may give you a splint to wear to stop you moving your joint.
• Keep your joint cool and don't cover it. Ice the affected joint using an ice pack or ice wrapped in a towel for about 20 minutes at a time to reduce swelling and bruising. Don't apply ice directly to your skin as it can damage it. If you need to repeat this, let your joint return to its normal temperature first.
• Drink enough water.

Medicines
There are medicines your doctor can prescribe to help to ease your pain and swelling from gout.

Your doctor may prescribe non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, which may relieve pain and inflammation. If you have a heart condition, high blood pressure, kidney or lung disease, or if you're over 65, these medicines may be harmful, so you need to talk to your doctor before taking them. Don't take aspirin because this medicine can affect your uric acid levels and make your gout last longer.

If NSAIDs aren't suitable for you, your doctor may prescribe a medicine called colchicine instead. Colchicine also reduces inflammation, but in a different way to NSAIDs. You may have side-effects from this medicine including diarrhoea, but this can be reduced by taking lower doses.

Occasionally, your doctor may prescribe steroid tablets if you can't take NSAIDs or colchicine. Alternatively, he or she may recommend a steroid joint injection if you have gout in a large joint (such as your knee).

Identifying things that cause you to have gout symptoms can help you to eliminate these triggers and reduce your chances of having it again. Gout can be prevented from reoccurring so often and so severely by making changes to your diet and taking medicines if needed.

Diet
What you choose to eat and drink can have an impact on gout. There are some foods that are very high in purines, which can increase the amount of uric acid in your blood. It's best not to eat much of these foods very often. These include:

• liver and kidneys
• oily fish, such as mackerel, sardines and anchovies
• shellfish, including mussels, crab and shrimp
• certain vegetables, such as asparagus, cauliflower, lentils, mushrooms and spinach
• oats and oatmeal

If you're planning to make changes to your diet, ask your doctor or a dietitian for advice to ensure you still get all the nutrients you need. Eating a well-balanced diet will help you to manage your symptoms.

Aim to drink less alcohol – especially cutting out beer, stout, port and fortified wines because these can have the greatest effect on causing gout symptoms. Drinking enough water every day will help to dilute your blood and urine, lowering the uric acid levels in your body.

If you need to lose excess weight, doing regular exercise will help you towards your goal. The recommended healthy level of physical activity is 150 minutes (two and a half hours) of moderate exercise over a week in bouts of 10 minutes or more. You can do this by carrying out 30 minutes on at least five days each week.

Medicines
In addition to changing your diet, you may need medicines to prevent gout. These help control the levels of uric acid in your blood. The aim is to prevent you getting gout again and if you do, make it last for a shorter time and be less severe. These medicines aren't used to treat symptoms of gout and are usually prescribed several weeks after your last gout symptoms have gone. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

This information was published by Bupa Group's Health Content Team and has been reviewed by appropriate medical or clinical professionals. To the best of their knowledge the information is current and based on reputable sources of medical evidence, however Bupa (Asia) Limited makes no representation or warranty as to the completeness or accuracy of the Content.

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