Dr Tariq Jagnarine
Fam Medicine, Endocrinology/ Diabetes
Gout attacks – inflammation of the joints, with severe pain and swelling due to urate crystals’ build-up – can vary from person to person. Some people have an attack every few years, while others have an attack every few months. Without medication, attacks tend to happen more often, and other joints can become affected.
Having high urate levels and gout for a long time can lead to other health problems. These include:
* Narrowing of the arteries – which can lead to an increased risk of stroke or heart attacks, or other heart problems
* Osteoarthritis – which occurs when the urate crystals and hard tophi cause joint damage.
* An increased risk of developing kidney disease or worsening of pre-existing condition
* Kidney stones
* Increased risk of some cancers, especially prostate cancer
* Mental health problems, including depression
* Underactive thyroid
* Erectile dysfunction in men.
TREATMENTS
Treatments for gout are easily managed. The two main areas of focus include:
* Treating the acute attack
* Treatments to prevent future attacks.
* Treating a gout attack
Treating an attack of gout does not lower the urate levels or stop future attacks. The treatment helps to manage all the symptoms when an attack happens.
The most commonly used drug treatments for attacks of gout are:
* Non-steroidal anti-inflammatory drugs (NSAIDs)- such as ibuprofens, diclofenac
* colchicine
* steroids.
The treatment for gout is patient-centred and requires the best approach for the patient, based on their circumstances. In cases where one drug does not seem to be working on its own, a combination of NSAIDs with either colchicine or steroids can relieve the symptoms.
TIPS FOR MANAGING AN ATTACK AT HOME
* Keep the area cool: An ice pack, or a bag of frozen food wrapped in a tea towel, can be particularly good at reducing some of the pain and swelling.
* Rest the affected joint.
PREVENTING GOUT ATTACKS
There are available drugs that can lower urate levels, prevent new crystals from forming, and dissolve the crystals in joints. They are called urate-lowering therapies. Treatment with these drugs is generally started after an attack of gout has completely gone. There is no single fixed dose, and different people need different doses to get to the right blood urate level.
It can take a few months or years for the drugs to completely clear the body of urate crystals. However, once the crystals are gone, attacks of gout are drastically reduced, along with tophi or risk of joint damage due to gout. The drugs may not be effective immediately, and may have to be taken along with other painkillers. Urate-lowering therapies are usually life-long treatments, and yearly check-ups are required to monitor urate levels.
* Allopurinol
Allopurinol is the most commonly used urate-lowering therapy. It is a very effective treatment for most people with gout. It works by reducing the amount of urate that the body makes.
* Febuxostat
Febuxostat is a newer drug that reduces the amount of urate made in the body in the same way that allopurinol does.
* Uricosuric drugs
Uricosuric drugs, which include sulfinpyrazone, benzbromarone and probenecid, work by flushing out more urate than normal through your kidneys.
TREATMENT FOR JOINT DAMAGE
If the gout has caused damage to joints, then the treatments available will be the same as those used for osteoarthritis. They include:
* Exercising regularly
* Reducing the strain on affected joints
* Staying at a healthy weight
* Taking painkillers
* In more severe cases, joint replacement surgery.
LIFESTYLE CHANGES
Lifestyle choices are not the main reason why most people get gout. However, with a healthy lifestyle and taking prescribed medication, there is a better chance of lowering urate levels. This will then decrease the chances of having attacks of gout.
* Exercise
Exercise is extremely important, not only to reduce the chances of an attack, but also for one’s general health and wellbeing.
* Diet
A well-balanced diet, that is low in fats and added sugars but high in vegetables and fibre, helps with weight management and prevention of diabetes, heart problems, hypertension, and promotes a healthier feeling. Avoid excessive weight loss, which can provoke gout attacks.
FOODS TO HAVE IN MODERATION
Avoid eating large quantities of foods that are high in purines. However, there is no need to remove them completely from your diet.
These include:
* Red meat – such as venison, kidneys, rabbit, liver, beef, duck and other wild meat.
* Seafood, particularly oily fish and shellfish – such as anchovies, herring, mussels, crabs and sardines
* Foods rich in yeast extracts – such as Marmite, Bovril and Vegemite
* Processed foods and drinks.
* Sweetened soft drinks should be avoided, as they contain large amounts of sugar, and can increase the risk of getting gout.
Alcohol
Drinking too much alcohol, especially beer and spirits, can increase urate levels and the chances of triggering a gout attack. Beer is particularly bad, as it contains many purines. However, drinking a bit of wine does not appear to increase the risk of triggering an attack.
Vitamin C
Research has shown that vitamin C may slightly reduce uric acid levels in people with gout. This is another reason to make sure the diet used includes plenty of fruits and vegetables.
Cherries
Research has shown that cherries may reduce the risk of having an acute attack of gout, particularly when taken with allopurinol.
Skimmed milk and low-fat yoghurt
Research suggests drinking skimmed milk and eating low-fat yoghurt may help to prevent attacks of gout.
WORKING WITH GOUT
Work can provide a sense of purpose, a supportive social network, and help financially. Most people with gout can continue working, but may need some time-off when they have an attack. If gout is affecting a person’s ability to work, speak to the employer’s occupational health service, if they have one. Being aware of dos and don’ts for gout, along with possible triggers, can help immensely in controlling this disease. While it may seem like an illness that restricts persons socially, check with a physician to help with a guide on what to do.
