Gout 

Gout is a recurrent and painful form of arthritis. Find out how it affects the body, the treatments available and why the condition is a warning to look at your whole lifestyle.

Find out more about gout

Transcript of Gout

My name's Philip Conaghan, I'm a rheumatologist and I work in Leeds,

predominantly at Chapel Allerton Hospital.

Gout is a recurrent, painful arthritis,

probably the most painful arthritis we know.

It predominantly affects males in their 40s

and it is associated with a number of conditions

such as obesity, high alcohol intake, high lipids in the blood

and probably genetic factors that we don't understand too clearly.

The major problem with gout is firstly the acute painful arthritis itself,

which is very painful,

and the typical onset of an acute attack of gout

is waking at three or four in the morning with excruciating pain,

usually in the big toe or ankle,

such that you can't even put a sheet on the affected area.

So it's normally exquisitely painful and tender.

There is a range of metabolic associated diseases

that come in association with gout,

so gout is a warning to look at whole lifestyle issues,

not just the arthritis.

It often starts in the big toe and ankle,

but over time it can affect knees, wrists, hands, elbows

and as well you can get hard deposits of crystals,

of these uric acid crystals,

deposited in your joints and under the skin,

so you get lumps on your elbow or little white crystals in your ears.

The management of gout involves management of lifestyle factors

and then treatment of acute and chronic attacks.

For the lifestyle factors we look at weight loss,

reducing alcohol intake,

especially beers, which are more prone than wine to causing gout,

reduction in shellfish and meat intake,

which are associated with high levels of uric acid after digestion,

and looking at having checks of blood pressure

and cholesterol and triglyceride, the fat levels in your blood.

So all these things are checked.

Treatment of acute gout generally involves drug treatment,

and the commonest drugs used are non-steroidal anti-inflammatory drugs

such as ibuprofen, diclofenac or indomethacin,

and colchicine, which is an old drug which also helps gout.

Another treatment that can be useful

for people who can't tolerate anti-inflammatory drugs or colchicine,

and both have significant side effects,

is some intra-articular, a small injection of cortisone-like steroid

into the joint itself,

or sometimes a small dose orally of cortisone for a few days

will help settle the acute arthritis down.

What most people want after they've had a couple of attacks of gout,

we know that their risk of getting chronic gout is high,

we want to stop them having the acute attacks,

the joint damage and the long-term problems,

and to stop people having gout you really have to go onto another drug

to reduce your uric acid levels down so low

that you will not have more gout attacks.

This is a condition that we can do a lot for

and really people can be very involved with their own treatment

and look after themselves a lot better.

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