Embarrassing Illnesses

We asked professor Philip Conaghan, consultant rheumatologist at Leeds Teaching Hospitals NHS Trust, what he would want to know if he were diagnosed with gout.

What is gout?

Gout is a recurrent, painful type of arthritis affecting 1-2% of men (it's less common in women). It usually affects at least one joint and is related to having increased levels of uric acid in the bloodstream, and uric acid crystals in the joint. 

What is uric acid?

Uric acid is a normal waste product of metabolism (when our body breaks down food). Usually, uric acid is expelled (excreted) by our kidneys.

People whose kidneys don't excrete uric acid properly, or those who produce too much uric acid, can have high levels of it in the blood. When the uric acid levels become very high, uric acid crystals form in the joints. These cause the joints to become inflamed, which is extremely painful.

Why do I have gout ? 

Genetic factors are important, although not everyone whose parents have gout will develop the condition.

Gout is commonly linked with obesity, poor kidney function, high alcohol intake, certain foods and, less commonly, the use of low-dose aspirin and diuretics. If you're susceptible to gout, eating a lot of meat and seafood increases the risk of developing it.

Why do people associate gout with rich living?

Rich living is associated with excess. Obesity, high levels of alcohol intake and high meat and seafood intake are all known risk factors, so it's easy to see why the link has been made. Unfortunately, this has led to a perception that gout isn't a serious condition, which isn't true.

How serious is it?

As well as causing severe pain, each attack of gout has the potential to damage a joint, so that secondary osteoarthritis ('wear and tear' arthritis) then affects
that joint.

Which joints does gout affect?

Most first attacks happen in the big toe or the ankle. Attacks often start in the early hours of the morning and are extremely painful and tender. Patients often say they can't even let the sheet touch their toe.

However, gout can affect a large range of joints, especially with repeated attacks. It can affect the knees, wrists, elbows or small joints of the hands.

I've heard it can cause lumps under the skin. What are these?

Over time, uric acid crystals can deposit in lumps underneath the skin. Each lump is called a tophus. These commonly occur on the elbows, over finger joints and sometimes in the ear lobes. A tophus is a sign that your uric acid levels have probably been high over a long period of time.

What should I do to alleviate symptoms during an attack?

The most effective treatments are drug therapies, which tend to work better if they're started soon after the attack starts. There are three options: anti-inflammatory pills called 'non-steroidal anti-inflammatory drugs' (NSAIDS); colchicine tablets; and anti-inflammatory steroids called 'corticosteroids'. (See 'Treatment' section for more information). Talk to your GP about which one is appropriate for you.

How can I prevent further attacks?  

Most people with gout will need life-long medication. The most common drug used to treat gout in the long term is allopurinol, which aims to reduce uric acid to the level where no further attacks of gout occur. It's well tolerated by most people taking it.

It's also important to look at your lifestyle and drink plenty of water. You may need to lose weight, cut out meat and shellfish from your diet, and reduce your alcohol intake.