Answers to your questions about GOUT

John Charles

/ Podiatrist

I’ve been seeing a few ‘gouty’ problems in the feet recently so thought it would be a good time to blog about it! There are thousands of online fact sheets on gout so to be different (and interesting) I’ll write this as a Q & A, answering the things I most commonly get asked as a podiatrist.

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What is Gout?

Gout is a common form of inflammatory arthritis. The most commonly affected joint is the big toe, but gout may be experienced in the feet, ankles and knees, and less commonly in the elbows, hands and other joints.

Gout occurs when uric acid builds up in the bloodstream and deposits urate crystals in the joint. These crystals form slowly over months or years. The crystals may interfere with normal joint function causing recurrent attacks of extreme pain, swelling and redness.

Urate crystals can also collect outside the joints and may even be seen under the skin, where they form small, firm white lumps called tophi. These aren’t usually painful but sometimes they break down and discharge fluid containing gritty white material – the urate crystals themselves.

Gout has characteristic symptoms but can best be diagnosed through seeing a doctor and getting your blood tested for elevated uric acid levels.

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Why have I got it?

Uric acid is a chemical created when the body breaks down substances called purines. Purines are found in some foods and drinks. Most uric acid dissolves in blood and travels to the kidneys. From there, it passes out in urine.

Gout can occur when:

  1. The kidneys are under-excreting uric acid
  2. The body is overproducing uric acid

Things that can cause this:

  • Having elevated levels of uric acid in the blood – this can be hereditary or caused by one of the reasons below. If other members of your family have gout you are more likely to get it. Gout is most commonly seen in men aged 30-50.
  • Consuming too much alcohol especially beer – the metabolism of alcohol in your body is thought to increase uric acid production, and alcohol contributes to dehydration. Beer is associated with an increased risk of gout, the effect of wine is not as well-understood.
  • Consuming too much of certain foods that are high in purines – meats and seafood high in purines are known to increase the risk of gout. This includes liver, kidney, anchovies, herring, sardines, mussels, scallops, trout, haddock, mackerel and tuna. Consuming vegetables high in purines (such as asparagus, spinach, peas, cauliflower or mushrooms) does not increase the risk of gout. Beans or lentils, which are moderately high in purines are fine too.
  • Being overweight or obese – your body produces more uric acid and your kidneys have difficulty excreting it.
  • Having a health condition or taking medications that uric acid levels – this includes diabetes, high blood pressure, high cholesterol, thyroid disorders, heart disease and kidney disease, Certain medications including diuretic (water tablets) and aspirin can also increase uric acid levels.
  • Crash dieting or fasting – this affects the balance between cell production and death and leads to more uric acid production. Fasting around an operation increases the likelihood of gout.
  • Being unwell with a fever, dehydration, or a recent injury – these are all events that can trigger a gout attack.

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Why is it so painful?

Gout presents as a sudden attack of pain, redness and swelling. This is because the urate crystals cause an acute inflammatory reaction in the joint.

How can I make it go away? Will it just keep coming back?

Your body will respond to gout like any other inflammatory process. Without treatment the attack usually resolves within one or two weeks, and with medication, it can be resolved within several days. Anti-inflammatory medications such as Neurofen and Voltaren can help in the management of a gout attack. You should also:

  • Adjust your diet if necessary
  • Keep hydrated
  • Refrain from any activities that place a lot of pressure on the affected joint

All these steps do not actually remove the crystals within the joint. It’s not clear why attacks of gout occur only now and then despite the continuous presence of crystals in the joint. There are indications that an increase in free fatty acids in the blood (such as after a rich meal with alcohol) may be the trigger that causes a gout attack.

Should I fly/travel if i’ve got gout?

Flying leads to rapid dehydration and joint swelling (due to the changes in air cabin humidity and air pressure). This will increase the severity of a gout attack and may trigger an attack if you have a history of gout. Fly with caution and ensure you stay hydrated during the trip!

What does gout medication do? Does it have any side effects?

When anti-inflammatory medication is not sufficient to control a gout attack, gout medication may be considered. There are two main types of gout medication:

  • Acute Gout Medication (Colgout, Colchicine) – can be used to treat acute attacks of gout. It is a toxic natural product which has a similar action to a non-steroid anti-inflammatory drug. It is only used during attacks of gout. Its main side effect is stomach upsets.
  • Chronic Gout Medication (Progout, Allopurinol) – can be used to prevent acute attacks in those with prolonged gout. It does not help during an acute attack. It reduces the production of uric acid. Its use requires careful monitoring as some people can experience serious side effects involving the skin.

These medications require careful monitoring by a doctor and are prescription only.

What other options are there?

A steroid injection to the affected joint will help to reduce inflammation and may help in the treatment and prevention of gout. In cases of severe build-up of gouty crystals, surgery may be required to clean out and preserve the joint.

Thanks for reading! Hope you have found out a bit more about this painful foot problem!