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ARTHRITIS FOUNDATION OF VICTORIA
www.arthritisvic.org.au  ... (Copy reviewed 2005)

GOUT 

Gout is one of the most common types of arthritis - one of 150 or more different types. As with many other forms, there is inflammation of the joint, with swelling, warmth, redness and pain.

Nowadays, due to advances in medical research, gout can be well controlled. If the correct treatment program is followed, gout need not be a major problem.

What is Gout?

It is a disease in which there is a build-up of uric acid in the body. A relatively small amount comes directly from the food we eat.

It is normally dissolved in the bloodstream and passed out through the kidneys. If the body cannot get rid of enough, the build-up of uric acid will be deposited in joints.

The first attack of gout usually involves the big toe or "bunion" joint. The ankle, foot and knee may also be affected.

It can occur over the point of the elbow, occasionally in the hand and rarely in other joints. Attacks can occur very quickly, often overnight, unlike most other forms of arthritis, which usually start more gradually.

The affected joint rapidly becomes very painful, often to the point that even the weight of a sheet is unbearable. Untreated, each attack lasts approximately a week. After the first attack, which almost always involves only one joint, it is usually months or years before the next one occurs. But without the right management, attacks become more frequent, last longer and may involve other joints.

Repeated attacks may accelerate joint damage. Uric acid can also deposit in other tissue.

These deposits are called "tophi". They usually occur near affected joints or around the elbow, toes, fingers and even the outer edge of the ear. Tophi usually take many years to be easily seen.

Attacks often occur for no obvious reason but can be triggered by:

• drinking alcohol
• over-eating
• minor injury to a joint
• drinking insufficient fluid
• attempting "crash" diets
• fasting, eg, before surgery

In some people, excess uric acid can be deposited in the kidney as stones or, less commonly, in the bladder as gravel or multiple stones. The can cause problems with kidney function and sometimes, severe pain.

Who gets gout?

Almost all people with gout have too much uric acid in their blood, a condition called hyperuricaemia. It usually occurs when the kidneys are unable to get rid of enough uric acid, which the body sometimes overproduces. Hyperuricaemia and gout can be hereditary. Fluid tablets can aggravate the condition because they hamper the kidney's ability to filter uric acid and thereby cause further build-up in the blood.

Being overweight, drinking too much alcohol or not drinking enough fluids can all aggravate the condition.

About 90% of people with gout are men. The first attack generally occurs between 40 and 50 years of age, but can occur at any age. Women with gout usually develop it after the menopause.

It is not, as once thought, a disease of the wealthy, although too much alcohol and over-eating are often associated with its development. About 70,000 Australians have the disease, which affects people from all walks of life.

Diagnosis

A sudden attack in one joint (usually the big toe) suggests a diagnosis of gout, but some other forms of arthritis can also act like gout, (especially pseudogout and septic arthritis). It is important for a doctor to make a diagnosis. The uric acid level can be measured by a blood test. It is usually raised during an attack but it can also be normal. A raised blood uric acid level does not necessarily indicate gout. To confirm the diagnosis it is sometimes necessary to take fluid from the joint to see if there are gout crystals.

Management

1. For the attack

   Non-steroidal anti-inflammatory drugs (NSAID's) are commonly used to control both the pain and the swelling. They are usually taken in moderate to full doses over a short period and are generally effective within two days.

   Colchicine has been used for more than 1500 years to treat inflammation caused by gout. Up to six tablets over a 24-hour period usually settle an attack. Lower doses over a longer period are sometimes prescribed.

   Corticosteroids, usually injected directly into the inflamed joint, are sometimes used and can control an acute episode. Each attack should be treated promptly to achieve best results.

2. Long Term

   The drug called allopurinol decreases the body's production of uric acid which, in turn, decreases its build-up in the body. It also allows uric acid already accumulated to pass through the kidneys.

   Uricosuric drugs increase the amount of uric acid passed in the urine. This lowers the uric acid level in the blood and allows it to be dissolved in the tissues. It is important to drink sufficient fluids to prevent kidney stone formation, but fluids are not used to treat an attack.

   Control of weight is important. Being overweight interferes with the body's ability to get rid of uric acid levels. These include liver, brains, kidney, sweetbreads, anchovies, leguminous vegetables, roe, yeast, broths, gravies and sardines. More than one glass of wine or one can of beer a day can also raise uric acid levels.

While it is important to drink a lot of fluid - at least two litres per day - particularly when there are kidney stones, exercise is also important to keep the joints mobile.

Gout can sometimes be associated with hypertension and other vascular disorders (eg. Coronary artery disease) so the blood pressure of people with gout should be checked regularly.

Proper diagnosis and management, including weight and diet control, should mean that gout can be totally controlled. For further information about self-management of gout, contact the Arthritis Foundation.