Gout – Still Painfully Misunderstood!

It’s the second most common form of arthritis in our country, and is more common in New Zealand than anywhere else in the world. Yet despite causing sudden, severe attacks of pain and tenderness, those who don’t suffer from gout, can be almost dismissive of it. The condition especially affects those in the 65 plus age bracket, those who are male, and those who are of Māori and Pacific origins. An often misunderstood condition, it can leave sufferers feeling ‘embarrassed,’ something largely attributable to a stigma created through historic literature. In various writings of the past, gout has been attributed to lavish living and an excessively rich diet, and has even been described as ‘the disease of kings.’ Research, however, has shown, comparatively, food and drink has less to do with the condition, than genetic factors.

Gout occurs because of a build-up in the body of uric acid. This acid is produced as a normal consequence of the body’s processing of food, and in those without gout, it is passed out of the body in healthy levels via the kidneys and urination. As excess uric acid in the body crystallises between the joints, it leads to inflammation and swelling. Joints affected may include the ankles, elbows, finger and foot joints, wrists, elbows, and knees. Common knowledge tells us the ‘big toe’ is a gout-prone area, and there is some science to back this up. Uric acid is very sensitive to temperature, forming crystals in the coldest parts of the body. One of the reasons why toes are a colder part of the body is they have a significant surface area through which to lose heat. As well as inflammation, swelling, and pain (which is likely to be most intense in the first 4-12 hours of an attack), gout can also result in a limited range of motion in affected joints.

Doctors use a range of tests to help diagnose gout. These may include a ‘joint fluid test’ (where fluid is drawn from the joint and tested for the presence of urate crystals), a blood test (to measure levels of uric acid in the body), ultrasound treatment (to test for crystals in joints and in tophi-visible lumps in soft tissues caused by untreated, chronic gout), and x-rays. Once a diagnosis of gout is made, treatment focuses on reducing the pain experienced during attacks, and lowering the amount of uric acid in your blood. Prescription medications may include anti-inflammatories, and those that lower uric acid levels.

As well as medications, attention to diet is often recommended as a way to reduce the level of uric acid in the body. Foods which are more likely to cause high uric acid levels in the blood include those with a high sugar content such as sweets and sugary drinks, processed snack foods containing sugars (including fructose corn syrup), game and organ meats, red meat, turkey, and some seafoods including scallops, mussels, tuna, and trout.

Alcohol is also to be avoided. This is not because all alcoholic drinks are high in purines (a compound in food which breaks down to create uric acid), but because alcohol pulls uric acid back into the body rather than allowing the kidneys to flush it out. As well as taking care with diet, weight loss can be another good management tool, as being overweight contributes to a slower removal of uric acid from the body.

Gout is a painful condition, but it is not deserving of social stigma, and if you suffer from it, there is no reason to feel uncomfortable talking about it. Moreover, by taking medications as prescribed, and adhering to dietary advice, there is much you can do to help yourself manage this common form of arthritis.