13/02/2025
GOUT
What is it?
Put simply it is too much Uric acid in our blood stream. Uric acid is normally found in our bodies- 2/3 of it comes from the normal process of cells dying off and being replenished the final 1/3 comes from our diet in the form of purines. These are normally broken down by our liver. 90% of Uric Acid is reabsorbed by our body and 10 % excreted.
When we have too much uric acid in our blood we develop Hyperuricemia. This is either because our body can not excrete the uric acid quick enough (the most common cause) or because our body is producing too much.
In the right conditions, Uric Acid changes to Monosodium Urate Crystals which are needle like in their shape
Who gets Gout?
1.4% of cases are related to where we are from. There is a clear association with diabetes and obesity. Gout is 6 times more common in men that women.
Presentation
Severe and distinctly agonising pain. Sudden onset of a hot red, inflamed joint.
In men, 85% of cases affect their feet, with 50% of first attacks affecting the big toe
In women it is more likely to affect their knee first, and more likely to affect hands than feet
Attacks are more common to start at night-time when our breathing is slower, causing CO2 to increase in our blood resulting in an increased blood acidity level. Our bodies are generally cooler and more dehydrated at night, and we produce less cortisol a natural anti inflammatory
Advanced cases- a build-up of the crystals leads to the formation of tophus. This can usually be seen beneath the skin surface as an iridescent white cyst like structure or nodule. If the skin is ulcerated, then it is clear to see the tophus as almost toothpaste like in its consistency.
Arthritic changes to the joints are also evident in long term gout sufferers
Diagnosis is usually based on clinical presentation, and a blood test to check urate levels
Management.
When an attack first occurs - Anti inflammatories such as Naproxsyn, alongside Colchicine to quickly lower the Uric acid levels
Chronic Phase – medications such as Allopurinol, alongside lifestyle changes. This should include losing weight, and reducing any alcohol intake, alongside following a diet lower in purines (please see photo attached for examples)
There have been several studies that also show the positive effect of including tart cherry juice, or Cherry extract capsules in your diet if you have gout.