Gout

Gout has a very long history. Hippocrates (c. 460 – c. 370 BC) identified gout (Greek: podogra) as different from other forms of arthritis. It is a member of the family of arthritides, it is inflammation of joints, but it differs because it is caused by the build up of monosodium urate crystals. These are often referred to as uric acid.

Two very brave gentlemen, Faires and MacCarty, investigated the role of these crystals in gout during the 1960's by injecting their left knee joints with them. Within four hours they were experiencing violent attacks of gout and the pain was excruciating.

Surveys have found that gout is an agonising and incapacitating form of  arthritis which "negatively affects daily activities, lifestyle and work "  (N. Lawrence Edwards, MD, Professor of Medicine, Rheumatology and Clinical Immunology, University of Florida College of Medicine) Flare ups are sudden, intense and last an average of 8 days.

Gout sufferers usually produce too much uric acid or are unable to get rid of the excess produced by their bodies. The uric acid forms needle-like crystals which are deposited in the joints. It typically affects one joint, often the big toe (62% of cases) and it can also cause feverish symptoms.

The presence of the crystals trigger an immune response, leading to  inflammation;  joint swelling, pain, heat, redness and stiffness. In some patients the condition can become chronic causing repeated flare ups, joint damage, kidney stones and kidney disease.

Gout tends to run in families, affects about 1% of the population and, it is more common in men than women.

For a long time, alcohol has been considered a trigger for gout attacks.  Little research has been carried out in this area, although one recent study on 197 subjects found that alcohol can  trigger recurrent gout attacks, usually occurring within 24 hours of consumption.

Dehydration is another factor often associated with gout. During periods of increased perspiration, less uric acid is excreted and so at times of high humidity and high temperatures, those prone to gout should drink lots of water. 

A very interesting paper in 2007 (Arthritis Rheum. 2007;56:2048-2054,) connects a reduced incidence of recurrent gout attacks in men over the age of 40 with coffee drinking,

"A study of a nationally representative sample of US adults showed that coffee consumption was associated with a lower serum level of uric acid and a lower frequency of hyperuricemia."

Many gout patients are managed with Allopurinol, the urate lowering drug, with varied success. Allopurinol will not work during an attack as it is not a painkiller and, it may take up to 3 months to be effective against another episode.

If you are unfortunate enough to suffer with gout, one of the most painful conditions known, please reduce your alcohol intake and  increase your fluid levels, especially in hot and humid weather.  Your GP can prescribe painkillers for use during an attack; it's worth paying a visit.

For more information on Podiatry, click here: The Footcare Clinic