Gout
Gout is a common and very painful type of arthritis that occurs when uric acid crystals form in and around a joint. It more commonly affects men, especially after the age of 40. Gout can usually be well controlled with medicines and changes to diet.
Uric acid (urate) is one of the body’s waste products. If uric acid builds up in the bloodstream, it can settle in and around joints as crystals. Uric acid crystals irritate the joint, causing the inflammation and pain of a gout attack.
People who get gout usually have a high level of uric acid in their blood. Gout commonly affects one joint at a time, most often the big toe joint, but can affect knee, ankle, foot, hand, wrist, and elbow joints.
Signs and symptoms
A gout attack usually comes on suddenly, often overnight. Common symptoms include:
* Joint inflammation, with swelling, redness and heat
* An extremely tender and painful joint, which is sensitive to touch - sometimes even the weight of a bed sheet can cause severe pain.
If a fever is also present, it is important to consult a doctor as soon as possible.
Without treatment, a gout attack usually lasts about one week. After having one gout attack, more attacks are likely. The time between gout attacks can be days, weeks, months or years.
If gout is not managed correctly, the time between attacks may get shorter, attacks may last longer and more joints may be affected. A joint can be permanently damaged by repeated gout attacks and kidney problems can also develop.
Contributing factors include:
* A family history of gout
* Drinking too much alcohol
* Being overweight or overeating
* Joint injury or surgery
* Certain medical conditions
* Certain medicines (e.g\, some fluid tablets)
* Crash dieting or fasting
* Not drinking enough fluids.
Some foods may also increase the level of uric acid in the blood.
Reducing or eliminating some or all of these factors may reduce the risk of future gout attacks and the need for long-term gout medicine.
Foods that can increase uric acid levels:
Foods high in proteins and purines can increase uric acid levels. For example:
* Large amounts of meat
* Sardines, herrings, anchovies, shellfish
* Liver, kidney, brains, sweetbreads
* Meat extracts (e.g., Bonox, Bovril, gravies)
* Baker’s and brewer’s yeast
* Vegemite, Marmite, Promite
* Dried beans and peas
* Asparagus and mushrooms.
Self care
* At the first sign of a gout attack, it is best to consult a doctor and start ‘gout reliever’ medicine promptly.
* Avoid vigorous exercise during a gout attack, but keep your joints mobile with regular moderate intensity exercise.
* Limit alcohol consumption. Try light beer and low-alcohol wines and avoid drinking a lot of alcohol at one time (binge drinking) as this may bring on an attack.
* Drink at least two litres (eight glasses) of water every day (unless your fluid intake has been restricted by your doctor).
* Reduce your dietary salt intake.
* Eat a healthy diet and avoid foods that can increase uric acid levels.
* Keep to a healthy weight.
Medicines
There are two types of gout medicine - ‘gout reliever’ medicines to relieve acute attacks and ‘gout preventer’ medicines to prevent attacks.
Relieving attacks
Medicines that reduce pain and swelling are used to relieve gout attacks. They should be started at the first sign of symptoms and taken until the attack has settled or for as long as directed by your doctor. Medicines to relieve an acute gout attack include:
* Non-steroidal anti-inflammatory drugs (e.g., indomethacin, diclofenac, ibuprofen)
* Colchicine
* Corticosteroids (e.g., prednisolone).
Aspirin should not be used for pain relief during a gout attack, as the doses needed for pain relief can increase the uric acid level in blood. Low-dose aspirin can usually be continued - check with your doctor or pharmacist.
Preventing attacks
Gout preventer medicines help to prevent gout attacks, by lowering uric acid blood levels. They can also help existing uric acid crystals to dissolve and stop new crystals forming.
* Allopurinol is the medicine most often prescribed by doctors to prevent gout. Probenecid is sometimes used as an alternative.
* A ‘gout preventer’ must be taken regularly every day, whether or not you have any symptoms.
* A ‘gout preventer’ will not relieve the symptoms of a gout attack and if ‘preventer’ treatment is started during an attack, it can make gout symptoms worse. Treatment with a ‘gout preventer’ should start when gout symptoms have settled.
* Gout attacks may continue during the first 3-6 months after starting a ‘gout preventer’. Your doctor may advise you to also take a ‘gout relieving’ medicine during this time.
* Treatment with a ‘gout preventer’ is usually life long.
For more information
Arthritis Australia - phone 1800 011 041 or website www.arthritisaustralia.com.au
HealthInsite - website www.healthinsite.gov.au
Consumer Medicine Information (CMI) leaflets - your pharmacist can advise on availability.
NPS Medicines Line - phone 1300 888 763 Monday to Friday, 9am to 6pm EST.
The Poisons Information Centre - in case of poisoning phone 131 126 from anywhere in Australia.
Pharmacy Self Care Support - phone 1300 369 772 and ask for the Pharmacy Self Care Field Officer.
Pharmacists are medicines experts. Ask a pharmacist for advice when choosing a medicine.
