Gout is a disorder of the joints where crystals of uric acid (or urate) collect in the joint space causing pain, inflammation and swelling. Gout affects around 1% of the population. It is most common in men over the age of 45 and people perceive it as a disease of overweight middle-aged men who enjoy a tipple too many, but it can affect men and women of any age, whether they drink or not. Gout treatment can be very effective but it needs to be started promptly to avoid damage to your joints. If you have private healthcare insurance, choosing to pay for private treatment will mean you can be seen more quickly and possibly access a wider range of gout treatments.
This article on private gout treatment is by Kathryn Senior, a freelance journalist who writes health, medical, biological, and pharmaceutical articles for national and international journals, newsletters and web sites.
Gout is caused by high levels of uric acid in the blood. This may be due to excessive urate production caused by an underlying condition, or by uric acid not being cleared from the blood adequately. Attacks can sometimes be triggered by an intake of large amounts of food or alcohol, or following a trauma or taking certain medicinal drugs. Foods that are believed to increase levels of uric acid are those that are high in purines (types of protein) such as kidney, liver, shellfish, pulses, peas and spinach. Alcohol and certain medications such as diuretics (water tablets) and aspirin can cause a build up of uric acid in the blood by affecting kidney function. People with kidney damage are also more prone to gout.
If you develop gout, you will probably experience problems with your joints. Gout may affect only a single joint, most commonly the joint of the big toe. However, several other joints can become involved, most often the ankles, knees, elbows and wrists.
Gout generally occurs suddenly, causing swelling, pain and redness of the affected joint. The skin covering the joint may become red and shiny, and white lumps – urate crystals – may be noticeable under the skin’s surface. Gout can also lead to kidney stones and kidney damage due to blockages caused by the urate crystals. In severe or recurrent cases, gout can lead to permanent damage or deformity of the hands or feet. If you experience sudden joint pain, seeing a private specialist to get a prompt diagnosis can enable effective gout treatment to be initiated quickly enough to prevent this.
How is it diagnosed?
As gout has a very clear cause - the build up of uric acid in the blood and urate crystals in joints - it is relatively easy to test for this. Several techniques can test for and confirm gout as the cause of your joint pain. Following initial assessment of your symptoms and physical examination, a sample of blood is taken together with a smaller sample of the fluid from within the affected joint to check for uric acid and urate crystals. You will probably also have X-rays of the affected joint. Only when a firm diagnosis of gout has been made, will your specialist recommend starting gout treatment.
What types of treatment are available?
Gout treatment usually begins with painkillers and non-steroidal anti-inflammatory drugs (NSAIDs) to reduce the pain and swelling of the joint. However, NSAIDs are for gout treatment in everyone affected due to possible side effects. Some people find they simply don’t work in which case gout treatment in the form of steroids may be prescribed instead.
As well as dealing with the symptoms, some gout treatments target the underlying cause of gout:
- Colchicine is a drug that acts to reduce the build of urate in the body and can be used to treat acute attacks of gout.
- Allopurinol acts to stop urate being formed in the first place and is used long-term to prevent future attacks.
- Other drugs used in gout treatment, such as probenecid or sulfinpyrazone, act by increasing the amount of urate that is cleared from the body and excreted in the urine. Again, this is a long-term, preventative type of gout treatment that isn’t suitable for treating acute attacks.
Potential side effects
It is important to drink plenty of fluids while taking these medications and to be on the lookout for side effects. While both can be effective gout treatments, colchicine can cause diarrhoea and vomiting, while allopurinol can actually make your gout feel worse initially. This is because it causes the urate levels to rise before they fall. Your doctor may prescribe a combination of gout treatments including steroids or painkillers initially to combat these effects.
Gout can be triggered by certain foods and drinks, so part of your gout treatment may be to change your diet to reduce the amount of purines you take in. A dietician will be able to help you devise a diet that may avoid triggering gout in the future. Medical gout treatment should also be accompanied by self-help gout treatment strategies such as resting and raising the affected joint, keeping the joint cool, wearing splints or supports and avoiding vigorous activity.