Gout no longer just a disease of the rich - Medical Matters with Dr Tom Black
Gout is the most common inflammatory arthritis affecting 1-2% of the population. It is a very common problem presenting to GPs and you always know that it’s gout even on a phone consultation because it is a sudden intense pain in a joint and the patient talks about being an agony.
The most common presentation is pain and swelling in the big toe, but it can also affect knees, ankles, feet, fingers and wrists. There are a number of causes of gout but the classic presentation is of an older man who eats too well and drinks an excess of alcohol. Of course many patients with gout don’t abuse alcohol and other causes of gout are obesity, high blood pressure, and kidney disease. Some cases are due to medication that the patients are on such as fluid tablets and some patients may have a genetic history of gout.
The first thing to do if your big toe suddenly becomes swollen and painful is to get a diagnosis and the most accurate way to do this is with a blood test which shows an elevation of your blood uric acid. Gout is actually caused by an accumulation of urate crystals in and around the joints which causes the inflammation, pain and swelling.
The next thing you need to do if you suffer from gout is to fix your diet and reduce your consumption of red meat, seafood, sugary drinks and alcohol (especially beer).
The treatment for an acute flareup of gout will vary depending on the patient, any other conditions they suffer from and what medication they’re on. Painkillers and an ice pack would be a good place to start and then anti-inflammatory medication such as naproxen tablets is very effective at reducing the pain and swelling. Patients often take omeprazole along with these naproxen which will protect their stomach.
Another treatment which is very popular with patients is a short course of colchicine tablets for a few days which will reduce the intensity and duration of pain. A short course of a steroid drug can be used for an acute flareup of gout although this is an off label use in the United Kingdom. Blood tests can be done to check on the uric acid level and to make sure that kidney function isn’t compromised.
If a patient gets repeat joint attacks, there is a course of medication that a patient can stay on to prevent flareups called allopurinol and this reduces the uric acid levels in the blood. The treatment is usually started 2 to 4 weeks after an attack has settled.
So the key messages for gout are that most cases aren’t due to too much alcohol, there is effective treatment for flareups; it is worth making sure that no other problems exist and if there are recurrent attacks, it’s best to start on allopurinol.
Some of the most famous people who suffered from gout in history were Christopher Columbus, Benjamin Franklin and King Henry VIII and indeed the affliction is often known as the disease of kings. The number of cases of gout is increasing due to the higher levels of obesity associated with lower exercise levels. So it’s no longer just the rich who get gout but is common throughout society, which is at least democratic.