GOUT - Full extract 

A person with gout often looks rather obvious in the waiting room; the face is usually etched in pain and a soft slipper might be sitting on a swollen foot. A walking stick is often there to help the person feel more steady, but also to prod anyone who gets within cooee of the sore foot. Gout is a specific type of acute arthritis that frequently affects a single joint. It tends to recur and is extremely painful. The joint most commonly affected is at the base of the big toe. In an acute attack the toe will become hot, red and swollen. Even the weight of bedclothes can cause a lot of pain. Joints in the hand and even larger joints like the ankle and wrist can also be affected. Gout is not a new illness; studies on Egyptian mummies have confirmed that even the ancient pharaohs had their trouble with gout as well. 

The underlying disorder is in the metabolic pathway whereby the nuclear material of cells (DNA) is broken down through a series of steps to form uric acid. It may be a case of too much uric acid being produced, or not enough being excreted through the kidneys. The level of uric acid in the blood rises, and crystals form in the joint, causing intense inflammation. All types of meat are rich in substances that are broken down to uric acid and may provoke an acute attack; people who suffer from gout should have only a small amount of meat in their diet. Alcohol intake should also be kept to a minimum. Foods like liver, pate, brains and tinned sardines should probably be avoided altogether. 

An elevated uric acid level can cause other problems as well. Uric acid crystals can form in the kidneys, causing kidney stones. Chronic kidney damage can also occur. Cheesy deposits called tophi may form in the skin. They tend to appear around joints in the hands and feet, and in tissues near the elbows or on the ears. With better treatment of gout, tophi are seen less frequently these days. 

About 4% of Australian men suffer from gout, compared to 1% of Australian women, and it may run in certain families. Although not always the case, gout typically occurs in the overweight male who loves his meat and grog. Interestingly, it is the same person who tends to have an elevated blood pressure and high serum cholesterol and triglyceride level. An attack of gout should be a useful prompt for a general check-up to rule out other health problems. 

Gout can also be brought on by certain medications. Fluid tablets sometimes cause an elevation in the level of uric acid and may cause an acute attack of gout. Likewise, some blood disorders are associated with increased protein turnover and a rise in the uric acid level. Injury to a joint, surgery and even exposure to cold weather can all precipitate gout in susceptible people. 

Fortunately, gout is a condition that is readily treatable. In the acute instance, anti-inflammatory medications usually provide rapid relief. As usual, care should be taken with anti-inflammatory medications because of their capacity to cause gastric irritation symptoms. Colchicine is an alternative preparation, its only drawback being its tendency to cause diarrhoea. In people who experience recurrent gout there are long-term medications to prevent attacks altogether; Allopurinol works by blocking an enzyme that is required for uric acid production and is usually very effective. 

Medication is only part of the treatment for gout. Of more importance is the need to lose excess weight, improve diet and reduce alcohol where necessary. 

Health Tips:
* Gout is more than a painful joint. It should lead to an overall health-check. 

* Treating an acute attack of gout is often straightforward. Working out why it occurred is often more important.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001