Being awoken in the middle of the night by a sudden, searing pain in a big toe describes a typical gout attack, but for sufferers it is no laughing matter and for some it may be so severe that they seek emergency help for pain relief. Once referred to as the disease of kings, gout was primarily associated with wealthy overindulgence but today it is becoming increasingly common. Gout primarily strikes men but during the past 2 decades the incidence of gout in women has roughly doubled, particularly among older ladies.[1] Gout attacks vary in regularity and after the first attack, months or even years may go by before there is a recurrence. However, some sufferers experience frequent, severe flare ups that can result in joint damage if left untreated.
Gout vs Pseudogout
These two painful conditions are often confused as they have similarities but their root causes differ. Gout is a form of arthritis caused by an accumulation of uric acid crystals in and around joints while pseudogout results from excessive calcium pyrophosphate crystals and is termed calcium pyrophosphate disease (CPPD). In both cases, these crystals have the ability to activate severe and sudden bouts of localized swelling, inflammation and pain. The majority of gout cases involve the first joint of the big toe, otherwise known as podagra but other areas can also be affected including the instep, ankle, wrist, finger joints and knee. Pseudogout tends to affect more of the larger joints for example the wrist, knee, elbow or ankle. Gout attacks usually begin abruptly and reach heights of agony within 8 or 12 hours and then abate, whilst pseudogout attacks tend to occur over a length of days.[2]
Gout Complications
Gout pain should not be taken lightly as without treatment, gout can extend to other areas and, in some cases, lead to the development of severe degenerative arthritis. Suffers can also experience secondary infections, kidney stones and even kidney disease related to uric acid. In severe cases, nerve and spinal cord impingement can occur and a chronic form of gout called tophaceous gout causes uric acid crystals to be deposited in soft tissue areas, forming hard nodules that can lead to joint destruction.
Who is at Risk?
Though gout is far more common in men, advanced age is the single highest risk factor for both men and women and there seems to be a link between menopause, lowering estrogen levels and the possible onset of gout in women.[1] Unhealthy diet is another factor because foods and beverages that are high in purine levels can aid uric acid production. Obesity and hypertension are commonly associated with gout occurrences and the use of diuretics and other medications can also spike uric acid levels. An interesting study was conducted recently that showed that those with sleep apnea (uneven breathing during sleep) are more likely to experience gout. This suggests that there may be a link between cardiopulmonary function and increased uric acid levels.[3-4] Other conditions associated with a higher incidence of gout are high triglyceride levels, uncontrolled diabetes, high cholesterol, anemia and renal insufficiency.[5]
Prevention Tips
There are steps that can be taken to minimise or even prevent repeated gout flare-ups:
1 – Diet Changes and Weight Loss
It is well-known that alcohol, and beer in particular, is often a serious culprit but it is also important to cut back on sweet beverages, especially those containing sugar or high-fructose corn syrup. Even fruit juices, such as orange juice can raise uric acid levels and should therefore be minimised. A high level of hydration should be maintained by drinking plenty of water. Food triggers should be considered such as shellfish, red meat, organ meat, processed foods and refined carbohydrates, especially those containing fructose. Instead, a gout diet should focus on eating low GI foods and complex carbohydrates.[6] The benefits of dietary changes can have a ripple effect, assisting with weightloss, lowering cholesterol and improving general health.
2 – Regular Exercise
The human body needs movement to assist with various processes and consistent regular exercise helps to control weight, improve joint mobility, lower blood pressure and reduce the incidence of type 2 diabetes. All of these also minimise the chance of gout attacks.
Treatment Options
In acute gout cases anti-inflammatory medication can be prescribed for pain relief but in chronic cases, the focus is on lowering uric acid levels through the above lifestyle changes and specific medication. In addition to this, certain supplements can be used to reduce chronic inflammation that is associated with joint degradation.
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