Gout is a form of arthritis. The big toe is affected most but ankles, hands and knees also are involved. A gout attack usually comes on very quickly, often overnight, with extreme pain and swelling in the joint. The skin over the joint can become red and shiny. Without treatment, the pain usually goes away in about a week. Left untreated, however, over time attacks can become more frequent and more severe. Eventually, permanent damage to the joints is likely, with painful disability. Untreated gout also can lead to kidney damage, and increasingly it is becoming clear that gout is linked with obesity, high cholesterol, high blood pressure and diabetes – all of which are risks for cardiovascular disease (heart attack, stroke and angina). Gout is a condition that needs to be taken seriously, and not left untreated.

What causes gout? The proteins in the food we eat are digested and broken-down to produce a chemical called uric acid. If the body produces too much uric acid or, as is the case for most people with gout, the kidneys are unable to remove the chemical, blood levels of uric acid rise. Small crystals form in the joints and swelling and pain result. Gout attacks can be triggered by too much of foods rich in purines and alcohol. If you have experienced gout pain, or know you have high blood levels of uric acid, cut-down on, or avoid, eating foods such as offal (liver, kidney, tripe, sweetbreads and tongue), large quantities of red meat, shellfish (mussels, oysters, pipis, paua, kina), and large amounts of legumes (peas, beans and lentils). Drinking lots of alcohol, especially beer, also can bring on gout so it is best to cut right down and instead drink plenty of water.

Try eating foods rich in complex carbohydrates, whole grains, fruits (such as berries and cherries) and vegetables, including celery (known to reduce acidity in the system). Also try low protein, low fat foods such as chickpeas, hummus, poultry and fish. Some medicines can trigger gout, for example certain medicines for treating high blood pressure and fluid build up. Being overweight also can bring on gout attacks. Talk with your pharmacist for more information about gout and medicines.

The pain of an acute attack can be relieved with medicines such as non-steroidal anti-inflammatory drugs. These should be started at the first sign of pain. A different type of medicine, called allopurinol, is used to prevent gout long-term by reducing the levels of uric acid in the blood. It needs to be taken all the time, on a long-term basis, even if you have no gout symptoms at the time. Starting on preventative gout medicines should not occur until after an acute attack has passed, and often during the early stages of preventative therapy it is necessary to continue taking a reliever medicine to stop an acute attack coming on.

With gout, prevention really is better than trying to cure it. Preventing the build-up of uric acid means controlling your weight, blood cholesterol, blood pressure and blood glucose levels. If you only treat the acute attacks, rather than trying to control the underlying problem, kidney damage and cardiovascular disease increasingly are likely. So, don’t dismiss that bad pain in your big toe, or any other joint for that matter. Talk with your pharmacist or doctor, about pain relief, and about what you can do to prevent further attacks.



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