GOUT

What is it?

When we talk about gout, we usually mean inflamed joints caused by a collection of crystals which irritate one or more joints. Very occasionally, gout may also affect the kidneys.

What causes it?

Gout is caused by having too much of a chemical called uric acid in the blood. This may be because our bodies do not get rid of it effectively, or because our bodies are producing too much of it.

Who gets it?

About one in 200 people in the UK get gout at some time. It runs in families and is more common in men than in women. Women do not tend to get gout until after the menopause. It can be brought on by being overweight, drinking too much alcohol or eating a diet that is very rich in protein. Some drugs, such as water tablets, can also bring on an attack. So too can very strict dieting, extreme exercise or general illness. Often, though, there is no obvious cause.

What are the symptoms?

Most people's first attack of gout comes in the form of a painful swelling at the joint which connects the big toe with the rest of the foot. Other people may notice a painful swelling in the ankle, the knee, the small joints of the hands or feet, the wrist or the elbow. The pain and swelling often come on suddenly, and may wake you up. The joint will be shiny, red, hot and extremely tender. You might never get another attack of gout, but some people do get attacks again unless they take medicine to prevent it. If someone goes on to get more attacks over a long period, this is called chronic gout. It may cause damage to the joints, painless lumps called tophi, kidney stones and, rarely, damage to the kidneys.

When should I go to my GP?

Anyone who suddenly develops a painful, swollen joint should see his or her GP as soon as possible. A first attack of gout is not life- threatening but is very painful. Your GP will need to check there is no other reason for the swelling. If you have had attacks before and know what to expect, you may be able to treat yourself with anti-inflammatory tablets. Even so, you might need to make a routine appointment with your GP to get a check-up.

What tests will my GP do?

If your GP thinks you have gout, you may have to have a blood test to check how much uric acid you have in your blood. An X-ray is unlikely to be of any help.

What is the short-term treatment?

In the short term, your GP will prescribe an anti- inflammatory drug, unless there are reasons why you can't take this type of treatment. This will reduce the pain and the swelling. If you are taking certain medications, such as water tablets or aspirin, these may be changed.

Will I need long-term treatment?

If you get regular attacks, your GP will probably advise that you take a drug called allopurinol in the long term. The actual dose will depend on the results of your blood tests. Allopurinol can actually bring on an attack of gout or make an existing attack worse, so you must not start it until you have been free of symptoms for several weeks.

How can I stop it getting worse?

If you are overweight you should start losing weight without going on a crash diet, which can make matters worse. You should cut down on alcohol and rich foods.

Will I need regular check-ups?

If you only have one attack, you will probably not need to be seen again. If you start on preventive treatment you will need regular blood tests initially.

Will I have to go to hospital?

Most sufferers need never see a hospital consultant. However, if you get a lot of attacks, do not get better with treatment or have kidney problems, your GP may refer you.