09 June 2015

How to avoid gout

What do you think of when you hear the word ‘gout’?

Do you perhaps think of Henry VIII, or one of those satirical Regency cartoons showing an elderly man resting a bandaged foot while indulging in rich foods and alcohol? There are many myths about gout which persist today, even though we know more about this painful condition than ever before.

What is gout?

Gout is the most common form of inflammatory arthritis and occurs when crystals of sodium urate form inside joints. Typically, it presents with sudden, severe pain in the joint, together with redness and swelling. Gout attacks can last between three to ten days.

Gout is a chronic progressive condition and can develop in any joint, but it seems commonly to affect the big toe joint.

There is a separate condition known as pseudo gout that is caused by crystals of calcium pyroposphate form in the joints. See What is Pseudo Gout for more information.

Who gets gout?

An enduring myth about gout is that only older men can get it. Certainly gout is most common in men aged 30 and over, but it can affect people of all ages. Gout actually affects 1 in 7 older men and 1 in 16 older women. This makes it the most common type of arthritis after osteoarthritis.

According to the charity Arthritis Care, gout affects one in 40 people in the UK and since 1997, there has been a 30% increase in patients diagnosed with gout. Furthermore, this figure is increasing by 1.5% every year.

What causes gout?

The cause of gout is an excessive build-up of a usually harmless chemical called uric acid (urate) in the blood. Urate is made in the body every day and results from the break down of chemicals called purines. Urate is usually filtered out by the kidneys and excreted in urine.

When too much uric acid is produced, or not enough is excreted from the body, uric acid builds up and can cause tiny, gritty crystals of sodium urate to form in the joints and this leads to inflammation.

Whilst more men get gout than women, the risk for women increases after the menopause, as the body produces less oestrogen, which facilitates the excretion of uric acid.

Risk factors for gout

Age and gender.
High blood pressure.
Genetic predisposition (close relatives with gout).
Chronic kidney problems.
A diet rich in purines (found in foods such as sardines and liver).
Sugar-sweetened soft drinks.
Fruit and fruit juices with high levels of fructose.
Too much beer or spirits (contain high levels of purines).

Treatment for gout

It is important to get proper medical treatment for gout, as it can lead to long-term health problems, including joint damage, kidney stones, and cardiovascular disease.

Most people take anti-inflammatory painkillers to cope with gout attacks.

A key treatment for gout is known as urate-lowering therapy (ULT), which aims to lower uric acid levels sufficiently to prevent new crystals forming and help to dissolve existing crystals. This is done with drugs such as allopurinol or febuxostat.

ULT can eventually lead to a permanent elimination of sodium urate crystals and a ‘cure’ for gout. However, patients normally have to continue the treatment daily to maintain the effects.

How to avoid or prevent gout attacks

Getting appropriate medical advice and treatment if essential, but there are also some simple diet and lifestyle changes which you can take to prevent gout attacks. Here are a few suggestions to help you help your older parent avoid this painful condition:

Lose weight: Losing weight can help to lower uric acid levels in the blood, and will tend to improve general health. A calorie-controlled, sensible diet plan is recommended.
Exercise regularly: Regular exercise reduces urate levels and will therefore decrease the risk of developing gout. It also makes people feel more energised and healthier.
Drink less alcohol: It’s a good idea to drink less alcohol, especially beer, stout and port wines, as these are known to raise the level of uric acid in the blood.
Eat a balanced diet: Some foods contain very high levels of purines, which can raise uric acid levels. So it’s a good idea to limit consumption of these foods.
Foods to avoid include: offal (liver and kidneys), game (rabbit, pheasant), oily fish (sardines, mackerel, anchovies), seafood (mussels, crab, shrimp), and foods high in yeast and meat extracts such as Marmite, Bovril, and commercial gravies.
The best foods to eat include: fruit and vegetables, starchy carbohydrates (potatoes,bread, pasta, rice), some milk and dairy.
Cut our sugary drinks: Soft drinks sweetened with sugar are known to significantly increase the levels of uric acid in the blood, so avoid drinking these. Consumption of fruit juices high in fructose should also be reduced.
Drink plenty of water: Staying hydrated is important and will help to reduce the amount of uric acid in the blood, so drink plenty of water – up to 2 litres per day
Vitamin C: There is evidence that vitamin C (500mg per day) can reduce the risk of developing gout. It is thought that vitamin C increases the amount of uric acid excreted into the urine
Get regular blood pressure checks: People with gout tend to have higher blood pressure so it’s a good idea to have regular blood pressure checks – at least once a year.

Before encouraging your older parent to lose weight and make any dietary and lifestyle changes, it’s advisable to take them to their GP to discuss the most appropriate course of action for their particular circumstances.