Gout is closely linked to obesity and recent evidence suggests that our expanding waistlines are the main reason that it is on the increase, and developing in younger people (an obese man is likely to have his first attack at least a decade earlier than his slimmer peers).
All about gout: a guide to the causes and treatment of gout
It is caused by a build-up of uric acid in the body, a natural waste product of our metabolism. It accumulates for a number of reasons. Some people have a genetic glitch in their metabolism (1 in 10 cases run in families), but high uric acid levels are also closely associated with a meat-rich diet, excessive alcohol (particularly beer), being overweight, and male (men are five times more likely to be affected than women).
Accumulation of the uric acid is something that typically occurs over years, and the tissues of the body have to be saturated before crystals start to form in the joints.
Factors that can trigger crystalisation and gout include binge drinking, heavy physical exercise, illness, stress, dehydration, surgery, crash dieting and some prescription-only medicines (particularly diuretics).
Treatment is aimed at rapid relief of the pain using potent anti-inflammatories and that, along with lifestyle factors (see below), may be all that is required for one-off attacks, or those that recur infrequently. But people prone to regular attacks fare better on daily preventive medication (allopurinol) which lowers uric acid levels.
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Dietary measures to manage gout
Dietary measures centre on avoiding purine (a type of protein) rich foods such as meat (particularly red meat and offal), seafood, oily fish, and alcoholic drinks, (notably beer, red wine and port). Sugary fizzy drinks are also best avoided - they don’t contain purines but some sugars raise uric acid levels.
Dehydration and gout
Hydration is another important issue. Although the amount of water you drink has no direct effect on uric acid metabolism, it helps maintain optimum hydration increasing the likelihood of the acid staying in solution, rather than precipitating as crystals in the joints and tissues.
Unsurprisingly it is not unusual for attacks to develop during summer holidays thanks to the combination of dehydration and eating and drinking too much.
The diagnosis is normally made on the basis of the story, the appearance of the joint, and a blood test that confirms raised uric acid levels.
For more advice and information visit the UK Gout Society website at www.ukgoutsociety.org
Could it be gout?
- Gout presents in a number of ways, but the classic story is excruciating pain in a joint (the big toe in over half of cases) that comes on suddenly during the night.
- The affected joint is red and swollen, and the surrounding skin often taut and shiny (it may peel too).
- In some people attacks are preceded by thirst, and may be accompanied with mild flu-like symptoms.
- The discomfort normally peaks during the first 24 hours before starting to resolve over the next few days, with the joint returning to normal within a week or two.
- The more attacks you have, the longer they tend to last.