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Gout is a form of acute arthritis that usually affects the joints. However, it may also present itself in one or more of the tendons in the cartilage or as lumps (known as tophi) under the skin.
The condition is characterized by the following gout symptoms:
An attack of acute gout – sometimes called acute gouty arthritis – will normally come on suddenly and swiftly, generally overnight. The affected area will start to feel hot and the skin will become red and appear shiny. Within an hour or so, it may become so painful that even the bedclothes start to feel too heavy. In many cases the individual may also develop a mild fever.
The term gout is derived from the Latin word gutta, which means a drop – probably because it felt like red hot liquid dropping on to the area concerned. Gout is recognized as being one of the most painful conditions in medicine.
Although gout is usually associated with the base of the big toe, any joint in the body can be affected, and occasionally it can strike at more than one joint at once. Other areas affected can be the heel, ankle, knee, hand, wrist or elbow. However, it is thought that over half of first attacks affect the big toe. The patient will often limp into the doctor’s surgery wearing an open-toed sandal, as contact with shoes or socks can intensify the pain.
If left untreated a mild attack may last for a few days, but a severe attack can persist for several weeks, with some residual pain and discomfort for a further few weeks. After the attack, the area typically returns to normal. However, once the individual has experienced an initial attack, the chances are that other attacks will follow, becoming more painful each time and affecting further areas. In time, the pain will not resolve itself between flare-ups and disability ensues. Fortunately, with a healthy gout diet and lifestyle adjustments – and with medications should you wish to go down that route – the progress of the disease can be halted.
Gout occurs in adults of both sexes, but is thought to be at least ten times more common in men than in women. Levels of a chemical called uric acid (urate) tend to increase in men at puberty, and because it takes at least 20 years of raised levels to cause the symptoms of gout, men commonly develop it in their late thirties and through their forties. Women typically develop gout in later life, often in their sixties and seventies.
According to some experts, oestrogen – the ‘female’ hormone – protects against raised levels of uric acid, and when oestrogen levels fall during menopause, levels of uric acid begin to build up.
A recent survey by market analysts Taylor Nelson Sofres found that three per cent of adults questioned had experienced gout.
Gout is usually linked to raised levels of uric acid (urate) in the blood. Everyone has some uric acid. However, it is generally harmless and eliminated with the urine. It is only when levels are higher than normal that problems can occur.
Uric acid is a type of metabolic waste that cannot be broken down within the body. It is formed in the liver as the body degrades other waste products, through various chemical processes. The amount of uric acid produced each day is determined by the breakdown of nuclear DNA (see below) and the levels of energy used, both of which are proportionate to the body size of the individual – a large person will produce more uric acid than a small person, for example. The concentration of uric acid in our bodily tissues depends also on the balance between the amount produced by the liver and the amount passed out via the kidneys.
The ability of the kidneys to eliminate uric acid is determined to a great extent by inherited factors, as does the ability to clear uric acid from the blood and pass it out in the urine. Elimination of uric acid can also depend on the presence of other health problems, including kidney disease, and the type of medications taken.
In a healthy person, approximately two-thirds of the uric acid produced each day is passed out of the body in the form of urine. The remainder moves into the intestine and is broken down and eliminated in the faeces. When there is any excess uric acid it builds up in the bloodstream and is eventually deposited as urate crystals in the small joints and/or soft tissues.
Researchers have found that 75-90 per cent of people with gout have raised levels of circulating uric acid. Those with low levels suffer no apparent adverse effects.
Many of the foods we eat contain chemicals called purines. Purines are nucleotides – that is, they are the basic molecular building blocks of DNA. Along with other nucleotides, purines are sources of energy that drive most of our bodily processes. After digestion, some purines are absorbed by the intestinal mucosa into nucleic acids. The others are rapidly degraded into uric acid. It is when the ability of the kidneys to eliminate uric acid (via the urine) is compromised that raised levels of uric acid occur – a condition known as hyperuricemia. ‘Hyper’ means increased, ‘uric’ refers to uric acid and ‘emia’ (sometimes spelt aemia) means blood. Thus hyperuricemia means raised levels of uric acid in the blood.
Raised levels of uric acid can be caused:
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