Gout: The unusual arthritis pains

Apr 14, 2019 Dr Zulfikar Bux, Features / Columnists

By Dr Zulfikar Bux
Assistant Professor of Emergency Medicine

Historically, gout was known as “rich man’s disease”, because it was only found in the rich, who ate lavish diets, especially meats and alcohol. Developments in medicine have shown that a breakdown product of protein rich foods called uric acid was found in large deposits in joints of patients with arthritic pains from gout.
In the ancient times, only the rich could have afforded to eat extravagantly and unhealthily, but what was considered an excessive diet in ancient times is now easily accessible in the modern world. As a result, gout is becoming a more common presentation in our current generation. While some countries do not have many cases of gout, it can affect up to 10% of populations in some countries where diet is more immoderate and unhealthy.
I will enlighten you about this unusual form of joint pain.

WHAT IS GOUT?

Gout is a form of arthritis. It can cause pain and swelling in the joints. At first, it tends to affect only one joint — most frequently, the big toe. Uric acid can form sharp needle-like crystals that build up in the joints and cause pain. Uric acid crystals can also form inside the tubes that carry urine from the kidneys to the bladder. These crystals can turn into “kidney stones” that can cause pain and problems with the flow of urine.

WHAT ARE THE SYMPTOMS OF GOUT?
People with gout get sudden attacks of severe pain, most often the big toe, ankle, or knee. Often the joint also turns red and swells. Usually, only one joint is affected, but some people have pain in more than one joint. Gout attacks tend to happen more often during the night.
The pain from gout can be extreme. The pain and swelling are worst at the beginning of a gout attack. The symptoms then get better within a few days to weeks. It is not clear how the body “turns off” a gout attack. Patients with gout tend to have pain “flare ups” especially when their diet and lifestyle becomes unhealthy. In between these episodes, they tend to be symptom-free.
TREATMENT
Treatment for gout is geared around treating “flare ups” and using preventative methods including lifestyle changes and medications to prevent future episodes. Over-the-counter anti-inflammatory pain medications such as ibuprofen or diclofenac are usually used to treat the pain episodes. Sometimes your doctor may prescribe steroids if the pains are unresponsive to the anti-inflammatory medications. Allopurinol and colchicine are commonly used medication that decrease uric acid levels and help to minimize episodes of gout “flare ups”.
LIFESTYLE AND HOME REMEDIES
Medications are the most proven, effective way to treat gout symptoms. However, making certain lifestyle changes also may help, such as:
• Limiting alcoholic beverages and drinks sweetened with fruit sugar (fructose). Instead, drink plenty of nonalcoholic beverages, especially water.
• Limit intake of foods high in proteins rich in purine such as red meat, organ meats and seafood.
• Exercising regularly and losing weight. Keeping your body at a healthy weight reduces your risk of gout.
PREVENTION
During symptom-free periods, these dietary guidelines may help protect against future gout attacks:
• Keep your fluid intake high. Stay well-hydrated, including plenty of water. Limit how many sweetened beverages you drink, especially those sweetened with high fructose corn syrup.
• Limit or avoid alcohol. Talk with your doctor about whether any amount or type of alcohol is safe for you. Recent evidence suggests that beer may be particularly likely to increase the risk of gout symptoms, especially in men.
• Get your protein from low-fat dairy products. Low-fat dairy products may actually have a protective effect against gout, so these are your best-bet protein sources.
• Limit your intake of meat, fish and poultry. A small amount may be tolerable, but pay close attention to what types — and how much — seem to cause problems for you.
• Maintain a desirable body weight. Choose portions that allow you to maintain a healthy weight. Losing weight may decrease uric acid levels in your body. But avoid fasting or rapid weight loss, since doing so may temporarily raise uric acid levels.

The next time you have a painful and swollen joint, it just might be gout. It’s not just a rich man’s disease any longer, so ask your doctor about the possibility of having gout.

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