I believe this post resolves all doubts about Gout or Gouty arthritis focusing on solution for pain, lifestyle changes, nutrition and why it happened to you.
Here we go!
– Gout can occur in anyone, irrespective of age or sex, when the level of uric acid or, rather, sodium urate in their blood rises above its ‘solubility limit’ .
– Gout symptoms are now found increasingly in women, too, as diuretic drugs are prescribed to more middle-aged and older women with high blood pressure.
– Gout is a possible complication of chemotherapy for cancer or surgery, because cells die releasing purines into the blood stream responsible of gouty crystals.
– Gout usually starts with sudden onset, often at night. Gets worse on movement and scratchy. You feel it hot, swollen, pink joint, often the big toe. If untreated, it develops into your hands creating thopus bursts (large lumps) or knees.
– Its diagnosis is validated through the measure of the amount of urate in plasma.
– Swollen, inflammation and pain are not caused by the uric acid crystals in the joints but your immune system attacking those crystals.
– It is possible to have gout even if your levels of urate in plasma are normal. Or even having high levels or urate in blood but no goat symptoms. This can occur in people with renal failure.
– Excess uric acid is converted by the body into needle-like crystals because common salts (urate salts in this case) form neat crystals when they’re in excess.
– Applying cold into the area of gouty pain might relieve the swelling or pain, but can increase the size of the crystals making the condition even worse.
– Damage to toe joints caused by gouty arthritis can in fact act as a focus for osteoarthritis in later life, so it is in your interests to keep this damage to a minimum.
– Depending on how large the gouts crystals are, the damage in the joints can be irreversible.
– Purine-rich food (e.g red meats) and beer (especially real ale), can precipitate a gouty attack but may not be the only cause. Dehydration, heavy exercise, stress and several medicines can trigger these effects.
– Hyperuricaemia (high levels of urate in the blood) can be present for many years without causing any symptoms. However an attack of gouty arthritis can happen so sudden.
– Painful attacks of gouty arthritis come and go because sodium urate crystals can re-dissolve if or when their concentration in the plasma falls, and the excess is excreted through the kidneys. However, the concentration may rise again and more sodium urate may be deposited, causing a repeat of the symptoms.
– Women before the menopause are usually protected from gout because the normal levels of the female sex hormone oestrogen help to promote the excretion of uric acid from the kidneys. After the menopause, levels of oestrogen fall unless hormone replacement therapy (HRT) is undertaken, and women may have their first attack of gout in late middle age.
– Animals can also suffer from gout: birds, snakes or lizards because uric acid is the end-product of nitrogen metabolism. Birds excrete very concentrated uric acid – the white part of their droppings.
– Because it is not very soluble, uric acid is also deposited as ‘stones’ or an accumulation of crystals in the kidneys of some people with gout, especially if their urine is very acid. If the stones remain in the kidneys, they may increase the risk of infection in a kidney or other parts of the urinary tract.
– A mild degree of kidney damage can occur in people with gout but this does not necessarily imply that their kidneys are badly affected or that it will progress to kidney failure.
– It’s essential to get rapid treatment when joints suddenly become hot and painful, with red–blue coloration and swelling.
– Many people report a fever and general ‘unwell’ feeling when a gouty attack is imminent. This is probably the effect of chemical substances released in the blood as a result of the body’s immune response.
– Gout affect some joints, especially the big toe, and not others because in areas far from the heart where the blood is passing in tiny blood vessels (capillaries), blood flow is restricted and the temperature is slightly lower: these conditions encourage the sodium urate. The toe is the farthest part of the heart.
– As an acute attack draws to a close, you will need to wear soft and comfortable shoes to accommodate swollen joints, and they should be easy to get into.
– Even if you can get rid of the excess uric acid from my joints, your feet not necessarily will be permanently deformed. That depends on how badly deformed they were when you started treatment.
– Gout doesn’t get worse as you get older. Provided that your plasma urate level is well controlled (and this means taking your tablets regularly).
– Gout does not cause impotence but some of the diseases that often accompany gout may result in erectile dysfunction.
– Glucosamine sulphate is a supplement known as a help for pain and immobility in osteoarthritis. It is a natural component of the cartilage in our joints, helping the surfaces of the bones to move smoothly against each other. In your case, if the sodium urate crystals have damaged the surfaces of your joints, some damage may remain even if the crystals have been cleared, and the joints may feel ‘stiff’. There is no scientific evidence that taking glucosamine sulphate by mouth helps gout, or any other form of arthritis for that matter. But it seems to be harmless. It might help or not.
– Walking is recommended between attacks to help to get the crystals moving instead of being deposited in your toe joints but but running involves much more pressure on the joints (especially those of the big toe) and could spell trouble.
– Colchicine is usually given for gout. Colchicine has a number of useful effects but can also be toxic in high doses. In the controlled doses used for gout, it seems to prevent invasion of the joint by the inflammatory cells, thus also relieving the pain. It should be given within the first 12 hours of the attack if it is to be effective in acute gout. This is only a temporary remedy because you have to get rid of the excess uric acid from the joints in the longer term.
– When taken by mouth, colchicine causes diarrhoea in many people. It can also be given by injection into the veins but this is hazardous because it may upset the heart rhythm.
– Colchicine should never be given to a woman who is or may be pregnant. The drug affects the multiplication of cells, so the developing baby could be affected. Small amounts of colchicine have been found in other herbal extracts; for example, in a formulation of gingko biloba.
– Because the pain arises from inflammation around the joint, acute gouty arthritis responds either to colchicine or to one of the NSAIDs. These drugs relieve inflammation of any kind, being particularly effective in both acute and chronic forms of arthritis.
– Aspirin should never be used, because at normal doses it slows the excretion of uric acid from the kidneys and so can actually tip the balance towards an acute gouty attack.
– Paracetamol is a weak pain-killer (analgesic) that has the virtue of not irritating or ulcerating the stomach lining. For conditions as gout, paracetamol cannot help.
– You can gradually cut out colchicine or NSAIDs as your urate lowering drugs stabilise the urate levels at a low value or as the attack of gouty arthritis subsides. Keep some on hand, though, in case you have another gouty attack, and consult your doctor.
– Steroids (corticosteroids) are prescribed when NSAIDs are ineffective, for example in a serious acute attack or after an operation. Occasional use is acceptable, but steroids can have cumulative side-effects such as causing high blood pressure and osteoporosis (thinning of the bones, leading to fractures) if they are used repeatedly. That’s why you shouldn’t always have them.
– There is no scientific evidence that meditation has altered the course of hyperuricaemia or gout for the better. However, you may find that you can override the pain of a gouty attack to some extent if you are experienced in meditation. With all complementary techniques, you could try them in addition to the treatment.
– Acupuncture works here by blocking the ‘gate’ of the pain pathway. Therefore it can relieve the pain from a gout attack by letting blood flowing again from the toe, where it is blocked and stagnant.
– Caffeine (from coffee) and theophylline and theobromine (from tea) are chemicals that resemble uric acid in structure, and so can interfere with the methods used to identify and measure uric acid in the blood or urine. Coffee and tea are not the only sources: watch out for caffeine in any form of cola, headache pills and cold cures, and in pick-me-up drinks such as Red Bull or Lucozade, all of which will be labelled as containing caffeine. Similar chemicals may be found in herbal teas and in confectionery, desserts or hot drinks containing chocolate.
– Caffeine is a diuretic and also resembles uric acid. Although the caffeine molecule is similar to uric acid, its breakdown products are more soluble and so it is excreted readily from the kidneys, unless taken in very large quantities.
– Coffee, tea and cola drinks are so widely available that it would be difficult to imagine cutting them out completely but, because they are stimulants and habit- forming, it is probably wise to limit them to about three cups (or glasses) per day.
– Uric acid and other components are excreted at different rates throughout the day – and the first urine of the day is usually the most concentrated. Excretion of uric acid will vary according to when and what you have eaten during the day.
– Once your plasma urate level has settled back into the normal range following the introduction of urate-lowering drugs the Drugs to lower the level of urate in the blood 49 attacks of acute gout should become less frequent and less severe, and ultimately may peter out altogether, so that you become gout-free.
– A diet that is high in meat, fish or poultry is particularly bad in this respect as it leads to a high level of uric acid and acidic urine. The general rules are to drink a lot of water, and don’t take too much salt with your food or eat too many salty snacks. By passing at least two litres of urine a day, you will help to prevent the formation of stones made up of the less-soluble components.
– Cranberry juice is often recommended for people with urinary tract infections, as it seems to be the only fruit juice that actually acidifies urine enough to prevent the growth of bacteria in the bladder. Unfortunately, this acidifying effect would promote the formation of uric acid stones in the urinary tract, especially if you have a high rate of uric acid excretion and/or a low volume of urine. So you should avoid cranberry juice, but other fruit juices are all right in moderation.
– There is a balance between excretion and reabsorption of soluble components as urine is made in the kidneys. Uric acid goes back into the blood and is constantly recycled unless it is deposited as crystals in joints or as insoluble stones in the kidneys.
– There is a small possibility that the aspirin may cause your kidneys to retain a little more urate than previously, resulting in a rise in your plasma urate level. So it is a good idea for your blood to be tested from time to time.
– Vitamin C (ascorbic acid) at high doses is known to help the excretion of uric acid, when used without prescribed uricosuric drugs. These doses may also encourage diarrhoea, however, which could cause an overall loss of fluid from the body.
– The fact that you have stopped getting attacks of gout suggests that your plasma urate level is being adequately controlled (i.e. is being held within the normal range), and this is how it should be.
– Strictly speaking, once your gout treatment has stabilised (i.e. the plasma urate level is normalised and you have stopped having acute attacks) you may eat small amounts of purine-rich foods (and drink beer) in strict moderation without the risk of provoking further attacks of gout. But take care! Alcohol in general, and especially when drunk without food, has a specific effect that promotes the retention of urate by the kidneys.
– It is extremely important to maintain a good volume of urine, so you should drink more water when you feel feverish. Only in this way will you maintain your plasma urate in a constant satisfactory (and normal) level, thereby ensuring that you do not drift back into a tendency to get gout attacks.
– You can make a huge difference to your general health – and to the gout symptoms – by cutting down on calories, purines and beer. Measures that help fight heart disease, high blood pressure and diabetes – switching away from animal fats, salt and sugar – will also pay off against the painful wear on your joints.
– We know that classic gout is connected with what we eat because during the second half of the 20th century, a wide-ranging analysis of the chemical constituents of foodstuffs highlighted a direct link between a diet rich in purines and their role in triggering a gouty attack in susceptible people.
– If you are overweight, you should definitely try to cut the total amount of food you eat, to decrease the load placed on your joints, especially on your knees and feet. It increases the pressure on your joint making gout arthritis more painful and a larger formation of urate crystals.
– White wine is just as likely to promote an attack of gouty arthritis as a red wine with similar alcohol content, if you drink a quantity without food and cause dehydration. The same goes for spirits.
– You should restrict the amount of purine-rich foods you eat to prevent the formation of uric acid.
– It is essential to know what foods are particularly high in purines so that you can control your own treatment. If you have been eating less food over all than previously, you will already have cut your intake of purines. If you are not overweight and do not have diabetes or high blood pressure, you do not need to cut calories but you should reduce the proportion of purine-rich food in your meals. Eat the same as the rest of the family but avoid the foods on the list that are very rich in purines. It’s been seen an attack of gout brought on within hours in susceptible people simply by feeding them pâté sandwiches or a large plate of seafood.
– Purines are not labelled in the ingredient lists of packaged foods and ready-meals, but you should be able to see what proportion of a dish is meat or beans, for example. Ready-made dishes are often very high in salt, which can affect the filtration process in your kidneys. Remember to keep within the portion size recommended for one person.
– Suggested changes to your lifestyle will help you to better general health as well as reducing the frequency or severity of gouty attacks. It sounds very hard at first, but the pain of gouty arthritis might help to remind you of the advantages of taking control of your diet.
– Spinach, broccoli and asparagus have quite a high level of purines in them, so if you eat a portion with some meat, you may produce more uric acid than your kidneys can cope with. Perhaps you could eat them as part of a salad or a stir-fry meal with little or no meat, or just cut down on the portion size of these vegetables.
– Sodium citrate (in citrus fruit) or calcium oxalate (in tomatoes and strawberries) may have some effect on how much uric acid can dissolve in body fluids. This might explain why some people have reported ‘trigger’ foods that are not high in purines. I can’t find any research that has been done specifically into low-purine foods that can help people with gout.
– There is a genetic predisposition to suffer from gout, but it is a very small chance related. The “guilty” genes have not been identified yet.
– It seems more sensible to eat a larger meal at lunchtime so that there is time for your body to excrete uric acid during the day. This is not usually possible if you are out at work, so whatever arrangement you have should be maintained at weekends. Don’t ‘skip’ meals: try to keep to a regular routine that fits in with other members of the family. You will also need to drink at least two litres of fluid, spread over the day and evening. Getting up at night to pass urine is a small inconvenience compared with a gouty attack.
– People with gout are no longer condemned to live with a recurring painful condition and ultimately with permanent disability.
– Remember that part of the remedy is up to you – equally vital factors in controlling uric acid levels are weight loss or maintenance of an already healthy weight, avoidance of purine-rich foods and beverages, and rigorous control of your blood pressure. Taking care of your health or doing one session of acupuncture per month would be enough to keep your body balanced.
All information provided above is for information purposes only. A GP/doctor should be consulted if you suffer from gout or any other medical condition.
Photo by Klara Kulikova.
