Leading Podiatrist, Martine Abrahams on GOUT – “the disease of kings” or “rich man’s disease”

The topic for my blog this month is gout – an unpleasant and often debilitating disease, which can put you out of action for several weeks.  There have been a number of high profile sufferers throughout history – Henry VIII, Pavarotti, Jim Belushi and more recently, Jared Leto, who contracted gout symptoms after piling on 60lbs for a film role.

The incidence of gout has increased over the past few decades and now an estimated 1-2% of the Western population are affected by it at some time during their lives.  The main reasons for this trend seem to be the Western lifestyle/diet and longer life expectancy.

Gout is a type of arthritis, in which crystals of uric acid produced by the body, can form inside joints.

The most common symptom is sudden and severe pain in the joint, along with swelling and redness. The joint of the big toe is usually affected, but it can develop in any joint.

Symptoms can develop rapidly to their worst point in 6-24 hours and usually last for 3-10 days (this is sometimes known as a gout attack). After this time, the joint will start to feel normal again and any pain or discomfort should eventually disappear completely.

Most people with gout will have further attacks in the future.

The crystals may cause two problems:

• Some may spill over into the soft lining of the joint (synovium), which causes the pain and inflammation associated with gout
• Some pack together to form hard, slowly expanding lumps of crystals (“tophi”) which can cause progressive damage to the joint and nearby bone; this eventually leads to irreversible joint damage which causes pain and stiffness when the joint is being used

Factors that increase your risk of gout include:

• age and gender
• being overweight or obese
• high blood pressure or diabetes
• close relatives with gout (gout often runs in families)
• long-term kidney problems that reduce the elimination of uric acid
• a diet rich in purines; such as frequently eating sardines and liver
• drinking too much beer or spirits – these types of alcoholic drinks contain relatively high levels of purines

There are two main goals in treating gout, relieving the symptoms with painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs) and preventing future attacks with Allopurinol which can help lower levels if uric acid.  Lifestyle changes can also help – reducing weight and alcohol intake.

There is some good news for us women – men are more likely to suffer gout, as oestrogen reduces a woman’s levels of uric acid by increasing excretion of uric acid via the kidneys.  Sadly however, we catch up with men after menopause!

Gout can be very painful and distressing, but if you do suffer from acute episodes don’t despair, as attacks are usually short lived and lifestyle changes combined with anti-inflammatories can help a great deal.