Gout is a type of arthritis that mainly affects the small joints at the ends of the feet, caused by elevated levels of uric acid in the bloodstream. Primary gout occurs when there is no apparent underlying cause for elevated uric acid levels. It commonly affects men around 40 years of age or older, but can also occur in middle-aged women. Secondary gout is characterised by elevated uric acid levels in the blood due to an underlying disease process. This results from the body producing an excess of uric acid, surpassing its capacity to eliminate it. It can affect both men and women of any age. Primary gout is largely hereditary, meaning it runs in families, but the attacks are also influenced by environmental factors. A typical attack begins in the big toe, but other areas that can be affected include the foot, ankle, knee, small joints of the hands, and elbow. The pain in the affected area is suddenly severe and excruciating, often causing the sufferer to be unable to sleep. The affected area becomes so sensitive that even the bedclothes can cause pain. Localised redness and swelling may occur. Pain might decrease, but joint pain and swelling can last longer. Another attack could happen within 6 to 12 months. In subsequent attacks, more joints may be affected and the attack may become more severe. In some individuals, particularly the elderly, gout episodes become chronic, and crystals of uric acid metabolism byproducts are deposited over the affected joint, forming swellings known as tophi. Chronic gout can cause joint deformities over time, leading to disability. The primary trigger for acute gout attacks is alcohol, particularly beer. Drinks high in fruit sugar (fructose) also contribute to gout. Red meat, offal, tomatoes, and spinach have also been linked to the condition. Gout is more frequently observed in obese men, creating a cycle where obesity can lead to gout, making it difficult to exercise due to pain, and further worsening the obesity. Secondary gout often results from medications that elevate uric acid levels in the bloodstream, such as diuretics and certain anticancer drugs. Renal failure can also contribute to gout due to the impaired excretion of uric acid from the body. Elevated uric acid levels may also lead to kidney stone formation, worsening renal failure and further exacerbating the gout. Diagnosis of gout is made by high uric acid levels in the blood or finding the metabolite crystals in the fluid exuded from the tophi of affected joints. X-ray of the affected joint can rule out any other cause of joint inflammation. During an acute pain attack, any pain relieving medication can be given to provide relief. However, specific medications for gout are more beneficial. These medications mainly fall into two groups. One group reduces pain and inflammation of the affected joint, while the other removes excess uric acid from the blood. Steroids are also helpful, but long-term use can produce side effects such as peptic ulcers and osteoporosis. Treating the underlying cause can aid in curing secondary gout. It's best to avoid alcohol due to its associated health risks. Red meat, offal, tomatoes, peas, etc. should be consumed sparingly. Drinking plenty of water promotes good kidney function and aids in excreting excess uric acid from the body. Regular joint exercises are certainly beneficial for those dealing with recurrent acute or chronic gout. Exercise enhances joint flexibility and reduces suffering. Swimming, yoga, and aerobics are all useful forms of exercise. With certain precautions, a person suffering from gout can lead a normal and comfortable life. Dr Rachna Pande is a specialist in internal medicine.
