GOUT – More than just. pain in the big toe. This fairly common illness can more debilitating than you might think. what you can do to avoid the perils.

Far from a pain in the toe, gout can be a life changing condition

Gout. What do we lay people know; or think we know?

If you’re like me, then it’s broadly this: You hope you don’t get it. It’s very painful and there’s not much you can do to ease the pain immediately, which, by the way, is in the big toe. No beef or beer for a while and try to lay off the sea food. Then you’ll be as right as rain although, there’ll probably be a relapse at some point in the future.

Annoying, yes. Painful, yes. But nothing we should get too upset about? Think again. From the experience of a family member there’s a lot more to this condition which showcased my ignorance on the subject spectacularly.

The Mayo Clinic News Network informs and educates the public on matters of health and scientific research. It describes gout as “a common and complex form of arthritis that can affect anyone. It’s characterised by sudden, severe attacks of pain, swelling, redness and tenderness in one or more joints, most often in the big toe.”

You may have heard stories of people waking up in the middle of the night with the sensation that their big toe is on fire. Typically it’s hot, swollen and so tender that even the weight of the bedsheet may cause intolerable discomfort. But although common, this certainly isn’t confined to the big toe. Other commonly affected joints include the ankles, knees, elbows, wrists and fingers. 

The pain is likely to be most severe within the first four to 12 hours after it begins. But after the most severe pain subsides, some joint discomfort may last for several weeks. Some people may never experience gout signs and symptoms again. Others may experience gout several times each year. 

What’s also very important and the key to my family member’s lengthy journey to recovery is to realise that if left untreated, gout can cause erosion and destruction of a joint. This can lead to compensation injuries in related soft tissue areas and means that simply attempting to treat gout for the pain that endures, may not help to ease matters. In this situation, seeking examination and treatment of the other problems that gout has caused is a far more effective cause of action. 

But let’s not get ahead of ourselves. First of all, what causes gout?
  • Diet – Eating a diet rich in red meat and shellfish, and drinking alcohol (especially beer) and juices sweetened with fruit sugar (fructose), will increase your levels of uric acid, leading to an increased risk of gout. 
  • Weight – If you’re overweight, your body produces more uric acid, meaning your kidneys have a more difficult time eliminating it.
  • Medical conditions – Certain diseases and conditions increase your risk of gout. These include untreated high blood pressure and chronic conditions such as diabetes, obesity, metabolic syndrome, and heart and kidney diseases.
  • Certain medications – Low-dose aspirin and some medications used to control hypertension also can increase uric acid levels. 
  • Family history of gout – If other members of your family have had gout, you’re more likely to develop the disease.
  • Age and gender – Gout occurs more often in men, primarily because women tend to have lower uric acid levels. However, after menopause, women’s uric acid levels approach those of men. So, men are also more likely to develop gout earlier, usually between the ages of 30 and 50.
  • Recent surgery or trauma – Experiencing recent surgery or trauma can sometimes trigger a gout attack. In some people, receiving a vaccination can do the same thing.
So in some cases, there isn’t much we can do to prevent the condition. But we can help relieve things. 

Nonsteroidal anti-inflammatory drugs include ibuprofen and naproxen sodium.

Your doctor may recommend colchicine, which is an anti-inflammatory drug that also reduces gout pain. Corticosteroid medications, may control gout inflammation and pain and may be in pill form, or injected into your joint. All of the above may lead to side effects and your doctor can advise on this.

If you experience several gout attacks each year or if your gout attacks are less frequent but particularly painful, your doctor may recommend medication to reduce your risk of gout-related complications. If you already have evidence of damage from gout on joint X-rays, medications to lower your body’s level of uric acid may be recommended. Some of these will help limit the amount of uric acid your body makes. While others will improve your kidneys’ ability to remove uric acid from the body. 

In terms of everyday living with a view to preventing gout, lifestyle choices are important, so choosing healthier beverages will help. Also avoid foods that are high in purines. Red meat and organ meats, such as liver, are especially high in purines. Purine-rich seafood includes anchovies, sardines, mussels, scallops, trout and tuna. Low-fat dairy products may be a better source of protein for people prone to gout. Regular exercise to help keep the weight down will of course be a big help. Low-impact activities such as walking, cycling and swimming, which are easier on your joints, may be the most manageable options.

Make an appointment with your doctor if you have symptoms that are common to gout. After an initial examination, your doctor may refer you to a specialist in the diagnosis and treatment of arthritis and other inflammatory joint conditions, likely to be a rheumatologist.

Finally, some good news. While the list of foods to avoid here may seem a little depressing, if you already have gout, drinking coffee may help to reduce your chance of having a flare-up. This is because coffee is thought to help to lower the uric acid that your body creates and encourage its excretion.

Singapore-based Steve Dawson is a seasoned sports journalist and broadcaster who has covered thousands of sporting events at arenas, in studios and hunkered down in commentary booths.
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