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Gout is caused by a build up in the body of a chemical called Uric Acid which is a by-product that is produced when protein is broken down. When the levels of uric acid get beyond a certain threshold they can crystalize out in the lining of joints where they cause gout, and in the kidneys where they can form kidney stones.
In days of yore we talked of Tumor, Dolor, Calor and Rubor - swelling, pain, heat and redness - which are the hallmarks of a gouty joint. Gout tends to strike one joint and the classical site is that of the large joint of the big toe, but it can also affect joints in the hand, wrist, knees, ankles and hip. In the first 24 hours the pain is intense to the point that one of my patients told me that he could feel "the pressure of a shadow" crossing the affected joint! And talking of men, they are more likely to suffer from gout, but in the last few years, studies have suggested that the ladies are catching us up - this must be surely one "race" they would love to lose!
Commonly the diagnosis is made on a blood test, but the "gold standard" way of getting the right diagnosis is to aspirate some fluid from the affected joint and see the uric acid crystals under a microscope.
There are two aims of treatment, and the first is
The "get out of goal" treatment which is aimed to stop the suffering caused by an acute attack of gout, and includes NSAIDs for those who can tolerate or take them: steroids by mouth or into the affected joint (when fluid is aspirated for diagnostic purposes - this is done under local anaesthetic and actually gives instant relief): or Colchicine which has been around for almost 100 years now! The standard way of giving Colchicine often led to nausea and diorrhoea, but a newer shortened dosage has overcome some of it's unpleasant side effects, and it is able to rapidly reduce the level of Uric acid in the blood stream.
and the second aim of treatment is
Prevention: where lifestyle factors are important.
Because uric acid comes from the breakdown of protein, one of the triggers for an acute attack can be dieting without exercising. Losing your own body protein can lead to gout, so exercise helps you maintain your muscle bulk whilst losing your body fat.
Cut down on your daily protein intake of meat, fish and fowl.
Alcohol should be avoided
Drink 8 to 10 glasses of water a day to "flush" the system through.
The are medications that block the enzyme responsible for producing uric acid -such as Allopurinol and Febuxostat - and blocking this enzyme is the standard method of preventing a recurrence. However, you need to know that in the first few months of taking such medications, there is an increased chance of suffering an attack of gout, so counter measures need to be taken.