Gout is a type of arthritis, which cause
s inflammation of your joints. It causes pain and swelling, usually in one joint in your body – commonly your big toe. However, it can affect any of your joints, including those found in your:
s inflammation of your joints. It causes pain and swelling, usually in one joint in your body – commonly your big toe. However, it can affect any of your joints, including those found in your:
• feet and ankles
• knees
• hands, fingers and wrists
• elbows
• knees
• hands, fingers and wrists
• elbows
Gout is caused by a build up of uric acid crystals in your affected joints.
Gout affects about one to two in every 100 people in developed countries. It's more common in men, particularly older men.
Symptoms of gout
You may only ever have gout once in your life and it may go away without any treatment.
The first symptoms of gout in your affected joint include:
• severe pain
• swelling and warmth around the area
• red and shiny skin around the area, which may peel later on
• swelling and warmth around the area
• red and shiny skin around the area, which may peel later on
You may also have a mild fever.
If
you have gout that reoccurs over many years, you may have further
symptoms. This can include firm, white lumps developing beneath your
skin – these are made of uric acid crystals and are called tophi. Tophi
usually take up to 10 years to develop from your first episode of gout.
Having tophi can lead to a range of problems, including:
• the tophi becoming inflamed, which can cause discomfort
• tophi breaking down and leaking out a white, paste-like substance
• tophi breaking down and leaking out a white, paste-like substance
You
may want to discuss treatments to ease discomfort from having tophi
with a doctor. However, taking antibiotics for inflamed or leaking tophi
won’t help because tophi aren’t caused by bacteria.
These symptoms may be caused by problems other than gout. If you have any of these symptoms, see a doctor for advice.
Complications of gout
Having
gout won’t always lead to further problems, but you can reduce your
risk of having complications by having treatment and making changes to
your lifestyle and diet.
The most common
complication of gout is progressive joint damage, which leads to
long-term pain, deformed joints and eventually, disability. This may be
prevented by changes to your diet and by taking medicines that lower
your uric acid levels. There is also some evidence that prolonged high
levels of uric acid in your body can increase your risk of vascular
diseases, which may lead to a heart attack or stroke.
Other complications that you may have are as follows.
• Gout affecting several of your joints (called polyarticular gout).
• Getting kidney stones (if uric acid crystals collect in your urinary tract). This happens to between one and four in 10 people who have gout.
• Damage to your kidneys (if uric acid crystals collect in your kidney tissue).
• Getting kidney stones (if uric acid crystals collect in your urinary tract). This happens to between one and four in 10 people who have gout.
• Damage to your kidneys (if uric acid crystals collect in your kidney tissue).
Causes of gout
You
can develop gout if you have too much uric acid in your body. Uric acid
is a chemical that everyone has in their blood. It's a waste product
formed from substances called purines, which are found in every cell in
your body and certain foods. Uric acid is formed in your body when the
purines in foods you eat are broken down. It’s also formed when old
cells in your body are broken down and replaced by new cells. Excess
uric acid is passed through your kidneys and out of your body in your
urine. However, the level of uric acid in your blood can rise if:
• your kidneys don't pass uric acid quickly enough
• your body produces too much uric acid
• your body produces too much uric acid
If
the level of uric acid in your body is too high, it can form tiny
crystals that collect in your tissues, particularly in and around your
joints. This is what may cause your swelling and pain. These crystals
tend to form at a cooler body temperature, which is why gout is more
common in your fingers and toes.
You may have high
levels of uric acid, but not get gout, or you may get gout, but not have
high levels of uric acid. It's not known why some people develop gout
and others don't. However, there are certain factors that can increase
your likelihood of getting gout. You're more likely to get gout if you:
• are a man aged 30 to 60
• are a woman who has been through the menopause
• eat a diet that contains high levels of purines, which are found in red meat, seafood and some other foods
• drink too much alcohol, especially beer
• don’t drink enough fluids daily and become dehydrated
• take certain medicines, such as diuretics (water tablets), which increase the flow of urine from your body
• have a family history of gout
• have kidney disease meaning that your kidneys don't pass enough uric acid out in your urine
• are overweight, have diabetes or high blood pressure
• have psoriasis (itchy, dry and flaky skin), which can sometimes cause your body to produce too much uric acid
• are taking certain types of cancer medicines
• are a woman who has been through the menopause
• eat a diet that contains high levels of purines, which are found in red meat, seafood and some other foods
• drink too much alcohol, especially beer
• don’t drink enough fluids daily and become dehydrated
• take certain medicines, such as diuretics (water tablets), which increase the flow of urine from your body
• have a family history of gout
• have kidney disease meaning that your kidneys don't pass enough uric acid out in your urine
• are overweight, have diabetes or high blood pressure
• have psoriasis (itchy, dry and flaky skin), which can sometimes cause your body to produce too much uric acid
• are taking certain types of cancer medicines
Diagnosis of gout
Your
doctor will ask about your symptoms and examine you. He or she will
also ask you about your medical history and that of your family. Your
doctor may take a sample of your blood, which will be sent to a
laboratory to measure the levels of uric acid. Your blood sample may
also be tested to find out whether there may be another reason for your
symptoms.
You may need to see a rheumatologist (a doctor specialising in conditions that affect the joints) for further tests.
Your
doctor may remove some fluid from your swollen joint with a needle.
This usually causes no more discomfort than a blood test. If uric acid
crystals can be seen in the fluid under a microscope, you have gout. If
calcium crystals are seen, you have a similar condition called
pseudogout. The crystals formed when you have pseudogout are made of a
calcium salt called calcium pyrophosphate.
You may
need to have an X-ray of your joint in order to rule out other
conditions and to find out if any damage has occurred, but this isn’t
used to diagnose gout.
Please note that availability and use of specific tests may vary from country to country.
Treatment of gout
You
will usually have symptoms of gout for up to two weeks and then they
will go away, even without treatment. You may only have one episode of
gout in your lifetime, but it might return. Your symptoms of gout may
also be more frequent and last for longer.
Self-help
There are a number of steps you can take to reduce the pain and swelling from having gout.
•
Raise and rest your joint. Don’t do any vigorous physical activity.
Rarely, your doctor may give you a splint to wear to stop you moving
your joint.
• Keep your joint cool and don't cover it. Ice the affected joint using an ice pack or ice wrapped in a towel for about 20 minutes at a time to reduce swelling and bruising. Don’t apply ice directly to your skin as it can damage it. If you need to repeat this, let your joint return to its normal temperature first.
• Drink enough water.
• Keep your joint cool and don't cover it. Ice the affected joint using an ice pack or ice wrapped in a towel for about 20 minutes at a time to reduce swelling and bruising. Don’t apply ice directly to your skin as it can damage it. If you need to repeat this, let your joint return to its normal temperature first.
• Drink enough water.
Medicines
There are medicines your doctor can prescribe to help to ease your pain and swelling from gout.
Your
doctor may prescribe non-steroidal anti-inflammatory drugs (NSAIDs),
such as ibuprofen and naproxen, which may relieve pain and inflammation.
If you have a heart condition, high blood pressure, kidney or lung
disease, or if you're over 65, these medicines may be harmful, so you
need to talk to your doctor before taking them. Don’t take aspirin
because this medicine can affect your uric acid levels and make your
gout last longer.
If NSAIDs aren't suitable for
you, your doctor may prescribe a medicine called colchicine instead.
Colchicine also reduces inflammation, but in a different way to NSAIDs.
You may have side-effects from this medicine including diarrhoea, but
this can be reduced by taking lower doses.
Occasionally,
your doctor may prescribe steroid tablets if you can't take NSAIDs or
colchicine. Alternatively, he or she may recommend a steroid joint
injection if you have gout in a large joint (such as your knee).
Availability
and use of different treatments may vary from country to country. Ask
your doctor for advice on your treatment options.
Prevention of gout
Identifying
things that cause you to have gout symptoms can help you to eliminate
these triggers and reduce your chances of having it again. Gout can be
prevented from reoccurring so often and so severely by making changes to
your diet and taking medicines if needed.
Diet
What
you choose to eat and drink can have an impact on gout. There are some
foods that are very high in purines, which can increase the amount of
uric acid in your blood. It’s best not to eat much of these foods very
often. These include:
• liver and kidneys
• oily fish, such as mackerel, sardines and anchovies
• shellfish, including mussels, crab and shrimp
• certain vegetables, such as asparagus, cauliflower, lentils, mushrooms and spinach
• oats and oatmeal
• oily fish, such as mackerel, sardines and anchovies
• shellfish, including mussels, crab and shrimp
• certain vegetables, such as asparagus, cauliflower, lentils, mushrooms and spinach
• oats and oatmeal
If
you’re planning to make changes to your diet, ask your doctor or a
dietitian for advice to ensure you still get all the nutrients you need.
Eating a well-balanced diet will help you to manage your symptoms.
Aim
to drink less alcohol – especially cutting out beer, stout, port and
fortified wines because these can have the greatest effect on causing
gout symptoms. Drinking enough water every day will help to dilute your
blood and urine, lowering the uric acid levels in your body.
If
you need to lose excess weight, doing regular exercise will help you
towards your goal. The World Health Organization recommends a healthy
level of physical activity is 150 minutes (two and a half hours) of
moderate exercise over a week in bouts of 10 minutes or more. You can do
this by carrying out 30 minutes on at least five days each week.
Medicines
In
addition to changing your diet, you may need medicines to prevent gout.
These help control the levels of uric acid in your blood. The aim is to
prevent you getting gout again and if you do, make it last for a
shorter time and be less severe. These medicines aren't used to treat
symptoms of gout and are usually prescribed several weeks after your
last gout symptoms have gone.
Your doctor may
prescribe you a medicine called allopurinol to take daily. An
alternative is febuxostat if there is a reason why you can’t take
allopurinol. Both of these medicines prevent gout by stopping the
formation of uric acid. Both allopurinol and febuxostat may actually
cause more symptoms of gout when you first start taking them. To help
prevent this happening, your doctor may prescribe NSAIDs, colchicine or
steroid tablets for you to take alongside allopurinol or febuxostat for
up to three months. Make sure you drink enough fluids when taking these
medicines.
Your doctor may prescribe you other
medicines, such as probenecid, to increase the amount of uric acid that
is removed from your body in your urine.
Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.
Availability and use of different preventative treatments may vary from country to country. Ask your doctor for advice on your treatment options.
Availability and use of different preventative treatments may vary from country to country. Ask your doctor for advice on your treatment options.
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