Gout

Causes of gout

Gout is caused by an inflammatory reaction to urate crystals formed in and around the joints. You have urate in your blood but if levels rise too high, then this allows the build of tiny sharp crystals. In a flare of gout a reaction to these crystals results in pain, redness and swelling of the joint.

Things that may increase your chances of getting gout include:

• obesity, high blood pressure and/or diabetes
• having a close relative with gout
• kidney problems
• eating foods that cause a build-up of urate, like red meat, offal and seafood
• drinking too much beer, spirits, fruit juices or sugary drinks
• some medications like diuretics, beta-blockers, niacin and some chemotherapy medicines

Diagnosing gout

Your GP will ask about your symptoms and medical history, and examine the affected area, to help make a diagnosis.

They may also ask you about your diet and whether there’s any history of gout in your family.

Sometimes further tests will be needed to confirm the diagnosis and rule out other possible causes.

A sample of fluid may be taken from the affected joint. The fluid can be checked for the small crystals that cause gout. It can be tested for infection to rule out septic arthritis.

A blood test known as a serum urate test may be used to measure the amount of urate in your blood. A high level of urate is often linked with gout.

Your GP may wait for 4 weeks after a flare of gout before carrying out this test. The level of urate in your blood often falls during a flare and so levels measured when you have recovered will give a better indication of your risk of future flares.

You may also be tested to check your levels of C-reactive protein (CRP) in your body. High CRP levels can be found in patients with acute inflammation. This is frequently found in patients who are suffering from gout flares.

An X-ray is rarely used to diagnose gout because the condition isn’t usually detectable using this method.

But, an X-ray is sometimes used to help rule out similar conditions that affect the joints, like chondrocalcinosis. Chondrocalcinosis is a build-up of calcium crystals in the joints. It can also be used to assess whether there’s been any joint damage due to repeated or persistent flares of gout.

An ultrasound scan of an affected joint is a simple and safe investigation that’s increasingly used to detect crystals in the joints. It can also detect crystals deep in the skin that aren’t obvious during a physical examination.

If you have gout, your GP can offer treatment to:

• relieve your symptoms during a flare
• prevent further flares by prescribing urate lowering medicines like allopurinol

To relieve symptoms, you can use ice packs alongside medications such as:

• non steroidal anti inflammatory drugs (NSAIDs)
• colchicine
• corticosteroids

With preventative treatment such as allopurinol, many people are able to bring their urate levels down enough to dissolve the crystals responsible for gout. When this happens, flares stop occurring. However, this treatment usually needs to be continued for life.

What to do during a flare

Do

• take any prescribed medication as soon as you notice a flare starting; it should begin working within 2 to 3 days
• rest the affected limb and keep it raised
• avoid knocking or putting pressure on the affected joint
• keep the joint cool by removing any clothing covering it and applying an ice pack, such as a bag of frozen peas wrapped in a towel
• make sure you stay well hydrated

When using an ice pack, apply it to the joint for about 20 minutes at a time. Never place ice directly on your skin, and do not leave it on for longer than 20 minutes, as this could damage the skin.

If needed, you can reapply an ice pack again later during a flare, but wait until your skin has returned to its normal temperature before doing so.

Some practical changes to your daily routine can also lower your risk of further gout flares:

• Lose weight if you're overweight, and try to maintain a healthy weight.
• Avoid foods high in purine (the chemical involved in producing urate), such as red meat, offal, oily fish, seafood and foods containing yeast extract.
• Cut back on sugary drinks and snacks.
• Take regular exercise, choosing activities that don't put too much strain on your joints.
• Drink plenty of water. Staying well hydrated lowers the risk of crystals forming in your joints.
• Cut down on alcohol, especially beer and spirits, and avoid binge drinking.

There's evidence that taking regular vitamin C supplements can lower your urate levels, though the effect may only be small. Talk to your doctor first if you're thinking about taking vitamin C supplements, since they aren't suitable or safe for everyone.

Sometimes gout can lead to further problems, especially if it is left untreated. These can include:

• kidney stones
• small firm lumps of urate crystals under the skin, called tophi
• permanent joint damage

Psychological and emotional effects of gout

Gout can also affect your mood, work and home life. The severe pain of gout arthritis can make it hard to manage everyday tasks and get around. This can lead to feelings of depression or anxiety.

If gout is affecting your mood or making everyday life difficult, talk to your doctor. They will be able to offer treatment and support. There are also organisations that offer information and advice for people living with gout.

What is pseudogout?

Pseudogout can look and feel like gout arthritis, but it is caused by a reaction to a different type of crystal in the joints. It more commonly affects the knees or wrists.