Managing gout

Have you been diagnosed with gout and wondering where to start and how to adjust your lifestyle? Well here’s what you need to know about your condition.

What is gout?

Gout is a type of arthritis common in men. It can cause a sudden burning pain, stiffness, and swelling of joints, usually in the big toe. These attacks can happen over and over if the condition is not treated.

Fortunately, gout is treatable, and there are ways to reduce its recurrence. When left untreated, gout can harm your joints, tendons, and other tissues.

What causes gout?

Gout is caused by the accumulation of uric acid in the blood. Uric acid is produced during the breakdown of purines (chemicals produced in the body or from eating certain foods). Purines are found naturally in the body, and in steak, organ meats and seafood.

When uric acid levels in your blood are too high, it may form hard crystals in your joints. Your chances of getting gout are higher if you are overweight, drink too much alcohol, or eat too much meat and fish that are high in purines. Some medicines, such as water pills (diuretics), can also cause gout.

What symptoms am I likely to have?

The most common sign of gout is a night-time attack of swelling, tenderness, redness, and sharp pain in your big toe. You can also get gout attacks on your foot, ankle, knees, or other joints.

The attacks can last a few days or many weeks before the pain goes away. Another attack may not happen for months or years. See your doctor even if your pain from gout is gone. The build-up of uric acid that led to your gout attack can still harm your joints.

How is gout diagnosed?

Your doctor will ask questions about your symptoms and conduct a physical examination. Your doctor may also take a sample of fluid from your joint to test for uric acid crystals. This is the best way to test for gout. Your doctor may also recommend for a blood test to measure the amount of uric acid in your blood.

What does gout treatment involve?

To stop a gout attack, your doctor can give you a shot of corticosteroids or prescribe a large daily dose of one or more medicines. The doses will reduce as your symptoms also reduce.

Relief from a gout attack often begins within 24 hours if you start treatment right away. To ease the pain during a gout attack, rest the joint that hurts.

Taking ibuprofen or another anti-inflammatory medicine can also help you feel better. But don't take aspirin. It can make gout worse by raising the uric acid level in the blood.

To prevent future attacks, your doctor can prescribe a medicine to reduce uric acid build-up in your blood.

Can I suffer any complications?

Gout can advance to more-severe conditions, such as recurrent gout which you may never experience gout signs and symptoms again. You may also experience gout several times each year. Medications may help prevent gout attacks from recurring. If left untreated, gout can cause erosion and destruction of the affected joint.

Advanced gout: Untreated gout may cause deposits of urate crystals to form under the skin in nodules called tophi. Tophi can develop in several areas, such as your fingers, hands, feet, elbows, tendons and along the backs of your ankles. Tophis are not painful, but they can become swollen and tender during gout attacks.

Kidney stones: Urate crystals may collect in the urinary tracts of people with gout, causing kidney stones. Medications can help reduce the risk of kidney stones.

What diet is advisable if I have gout?

Although gout treatment is medicine based, diet may help control future gout attacks:

—Limit or avoid alcohol

—Keep your fluid intake high. Stay well-hydrated (8-16 glasses of water per day) if fluid is not restricted for any other reason.

—Limit sweetened beverages intake, especially those sweetened with high fructose corn syrup.

—Get your protein from low-fat dairy products. Low-fat dairy products may have a protective effect against gout.

—Limit your intake of meat, fish and poultry due to high purine levels in animal proteins.

—Choose complex carbohydrates. Eat more whole grains, fruits and vegetables are in your food as opposed to refined carbohydrates like bread, cakes, pizzas etc.

—Reduce fat intake by avoiding fried foods, removing all visible fat from meat before cooking, removing the skin from chicken before cooking, using skim milk and low-fat dairy products, not adding oil, margarine, or mayonnaise to vegetables, spreading margarine thinly on bread.

—Maintain ideal body weight, or lose weight if you are overweight.

— Eat regular meals and do not fast.

Dr Otieno is a consultant rheumatologist at Aga Khan University Hospital, Nairobi