Zakariya Waqar-Uddin column: Gout – more than an affliction of the affluent

Watch more of our videos on ShotsTV.com 
and on Freeview 262 or Freely 565
Visit Shots! now
Gout is perhaps one of the most misunderstood conditions. Folklore has advised us it is a minor irritation due to too much “fine living”, and that cutting back on such excesses is the cure.

The reality is somewhat more complicated. Gout is due to the build up of uric acid in the body. Uric acid is formed during the breakdown of purines, a type of protein in many food and drink products.

Hide Ad
Hide Ad

Normally uric acid is disposed of in urine with a small amount in faeces. This mechanism allows the body to maintain normal amounts of the chemical in the bloodstream.

However, if uric acid levels rise, this can result in painful needle-like crystals forming in the joints.

..
.

Though the classic picture is of an overweight, affluent middle-aged man nursing a red toe, after a heavy weekend, gout can occur in any joint, to any individual, and indeed at any point.

Hide Ad
Hide Ad

Interestingly, gout tends to attack joints already affected by other forms of arthritis, so it can literally occur anywhere.

It may also cause tophi, usually harmless, but sometimes troubling lumps under the skin.

While there is strong evidence to argue that cutting back on purine rich foods will help, genetics play as much if not a greater role in your likelihood of developing gout.

Hide Ad
Hide Ad

Furthermore, and somewhat confusingly, some individuals will have high uric acid levels and never develop gout, while others with normal uric acid levels will suffer the condition.

Though it affects men more than women, this advantage seems to reduce after the menopause, with the numbers evening up.

Perhaps the most important concern regarding gout is the conditions it is associated with, as well as the effects it can have on the body.

Hide Ad
Hide Ad

It is linked with several other significant diseases including obesity and type 2 diabetes.

While you may have no symptoms between attacks, raised levels of uric acid can cause progressive joint damage, resulting in worsening arthritis.

Kidney stones are a recognised complication, and if kidney function is reduced, uric acid levels will rise even further.

Hide Ad
Hide Ad

Most worryingly, gout is associated with a greater risk of heart disease, through raised levels of inflammation in the body.

So, gout is clearly more than a minor irritation, and hence something that should be taken fairly seriously.

Many will come to see their doctor after a first or second episode.

Hide Ad
Hide Ad

The pain tends to build over a few hours, and is often described as excruciating.

It is sometimes confused with cellulitis, or even septic arthritis.

A blood test will confirm the diagnosis, and while waiting for this you may be prescribed strong pain relief. This may be in the form of a non-steroidal anti-inflammatory (NSAID), such as naproxen. For those in whom this is less suitable, for example because of acid reflux, or raised blood pressure, your GP may prescribe colchicine.

Hide Ad
Hide Ad

An x-ray is sometimes ordered to rule out other forms of arthritis.

Some will have an isolated episode, with nothing further. However, many will have multiple presentations.

At this point it, it is usual for your doctor to prescribe a medication called allopurinol. Confusingly allopurinol may initially make gout worse. Hence it is not prescribed until the acute illness has subsided, and then often with NSAIDs or colchicine to be initially taken alongside it.

A blood test between six to eight weeks later will see if your uric acid level has been reduced sufficiently. If not, the dose is increased and the process repeated.

Once you are on allopurinol, it is likely that you will be on the medication long term. There are alternatives for those unable to tolerate allopurinol, the most commonly prescribed drug being febuxostat.

It is important to keep levels of uric acid within the correct range to prevent further flares, which can result in disability if the joints become sufficiently damaged.

On top of this, it is vital to maintain a healthy lifestyle.

A sensible diet and alcohol in moderation, if at all, are encouraged. While weight loss may be advised for the whole host of benefits it brings, crash dieting can actually make gout worse.

Beers tend to be higher in purines than wines, and switching may help for those who still wish to enjoy the occasional drink.

Most of all, please do not ignore an initial bout, as for the majority, the condition is less likely to resolve without medical treatment.

“Though the classic picture is of an overweight, affluent middle-aged man nursing a red toe, after a heavy weekend, gout can occur in any joint, to any individual, and indeed at any point.”

“The pain tends to build over a few hours, and is often described as excruciating. It is sometimes confused with cellulitis, or even septic arthritis.”

USEFUL WEBSITES

Dr. Zakariya Waqar-Uddin, General Practitioner

Comment Guidelines

National World encourages reader discussion on our stories. User feedback, insights and back-and-forth exchanges add a rich layer of context to reporting. Please review our Community Guidelines before commenting.