What causes Gout?
Uric acid. It is a chemical which is a natural part
of the normal breaking down and building up of food and tissues of the body. The level
in the blood can be measured and shows how much there is in the body overall.
The condition of raised blood uric acid is called hyperuricaemia. When this is
present, the uric acid which is normally dissolved in the blood may, from time to
time, form microscopic crystals in the joint. These crystals set up the
inflammation which is called acute gouty arthritis or acute gout.
It follows that gout may develop in persons
whose uric acid is higher than normal. There are many causes of this. The
following are some of the more common causes:
Higher than normal levels of uric acid can be
part of the inherited make-up of some families
Obesity
High alcohol intake
High intake of food containing purines (see
below)
Some of the drugs used to treat high blood
pressure.
Less commonly, longstanding kidney disease
may result in high blood levels of uric acid.
Gout is possibly one of the most common forms of
arthritis or joint inflammation. It appears as an acute attack often with
symptoms coming on
overnight. Within 12-24 hours there is found severe pain and swelling in the affected
joint or joints. The skin over the joint may be red and shiny. You may
also notice a bit heat emanating from the joint.
It is usually found that gout usually affects
only one or two joints at a time - most often around the feet and ankles. The
ball of the big toe is the most common site of attacks. Without treatment the
attack will usually subside in a week or so. When a patient first develops
gout there may be intervals of many months or even a few years between attacks.
But, as time goes by, these attacks tend to become more frequent and more severe
and eventually many joints may become involved, sometimes all of them at the
same time. At this stage a state of chronic or continuous joint disease may
develop with progressive joint damage, disability and crippling (chronic gout).
Gout affects mostly men and is very rare in women until after the menopause when
it is quite often seen. Gout is very commonly found around the world. Some
surveys have shown it to be present in up to 10% of adult males. It is
often said that dry, warm climates are the best to avoid outbreaks.
Treating the Acute Attack
One or other of the anti-inflammatory drugs (NSAIDs)
can be very effective but to gain the best results the dose should be adequate
and the drug taken as soon as possible at the first sign of an attack. Hence
medical advice must be sought early. With effective treatment the attack may be
controlled within 12-24 hours and treatment need not be continued after a few
days. Rest and elevation of the part involved and a fluid intake increased by an
extra 4 or 5 glasses of water a day are also important. Drugs used for the acute
attack have no effect on reducing uric acid levels.
Treatment of Gout
The first step wherever possible must be to
correct those factors mentioned above which give rise to high uric acid levels.
Purines are substances found in food, which, when broken down produce a lot of
uric acid. Therefore the following foods which are high in Purines should be
restricted or avoided: