Gout

Gout is an arthritic condition of the body connected with an excess of uric acid in the blood. It causes the joints to become red, swollen and painful. Uric acid crystals are deposited in joints, tendons, kidneys and other tissues where they cause inflammation and damage. The most common area on the body for Gout to occur is the joint of the big toe. Gout is not a single disease but is a syndrome resulting from high levels of uric acid in the blood.

Gout is primarily a disease affecting adult men. It is characterised by high levels of uric acid in the body. Uric acid is the end product of metabolism of the class of chemicals known as purines. Uric acid is a by-product of certain foods, so Gout is closely related to the diet. Some degree of kidney dysfunction occurs in most people with Gout and there is a higher risk of kidney stones. Gout may be associated with psoriasis, thyroid and parathyroid disease, cardiovascular disease, obesity and high blood pressure.

CAUSE
There are several possible causes of Gout. They include:
• Foods high in purines increase uric acid levels. See the Diet section in this topic. A high intake of protein, saturated fats, refined carbohydrates, coffee and meat, and a low intake of fruits and vegetables may also cause Gout.
• Drugs such as aspirin, penicillin, diuretics and insulin may reduce the ability to excrete uric acid from the body.
• Alcohol increases uric acid production and reduces uric acid excretion. Alcohol may also impair kidney function.
• Obesity may cause Gout.
• Hereditary factors.
• Insufficient exercise.
• Kidney disease or dysfunction leads to decrease clearance of uric acid.
• Lead toxicity.
Aspirin should not be given to children under 16 years of age unless specified by a Doctor.

SIGNS AND SYMPTOMS
Gout is characterised by intense pain, usually in the big toe. Other joints such as ankles, mid-foot, knee, wrists and even the fingers can be affected. Attacks of Gout pain often increase in colder weather. The feet do not have a strong blood circulation and that is why crystals of uric acid form in the big toe. These crystals are very painful. In an attempt to reduce the pain of Gout, keep feet warm. First attacks of Gout usually occur at night with a throbbing pain and are usually short lived.

TREATMENT OPTIONS
As with all conditions your Doctor should be consulted to diagnose and treat this condition. A simple blood test will diagnose the problem immediately. Usually any prescribed medicine is directed towards reducing the content of the uric acid in the blood and relieving the symptoms. Some patients have to take medication for long periods of time.
A variety of over-the-counter topical analgesics are available. These are usually creams or gels, which may be rubbed into the painful area several times a day. Such creams should not be applied to broken or irritated skin, and hands must be washed well after application. If it is your hands that are being treated, wear a pair of light cotton gloves to prevent creams from getting into the eyes. Creams may interact with oral medications, so always ask your Doctor or Pharmacist before commencing a new treatment.

DIET HINTS
• Avoid foods high in purines such as liver, kidney, heart, brains, pate, sardines, herrings, anchovies, mackerel, shellfish such as prawns and scallops, fish roe (fish eggs), yeast, beer, asparagus and yeast products.
• Drink plenty of water.
• Avoid alcohol.
• Minimise fructose (fruit sugar) intake.
• Reduce saturated fat intake as this may increase uric acid retention.
• Juices such as celery, alfalfa and carrot may help remove excess uric acid from the body.

VITAMINS/MINERALS/HERBS
Nutritional supplements may only be of assistance if the dietary vitamin intake is inadequate.
• Folic Acid may help reduce uric acid levels.
• Vitamin C, (500mg per day), has been shown to help reduce uric acid levels in the blood
• Celery Seed (Apium graveolens) may help reduce uric acid levels and also has anti-inflammatory actions.
• Ginger may help decrease inflammation.
• Nettle root may encourage the elimination of uric acid from the kidneys.
• Fish Oil can assist with reducing inflammation in the joints.
• Bromelain may dissolve uric acid crystals and can bring relief to a joint also inflamed by injury.
• Quercetin has natural anti-inflammatory effects and may prevent uric acid from forming.
• Devil's claw may relieve short-term pain and inflammation.

PHARMACIST'S ADVICE
Ask your MedAux Pharmacist for advice.
1. Follow the Diet Hints.
2. Drink 6 to 8 glasses of filtered water a day. An increase in filtered water intake can help the body excrete excess uric acid.
3. Ask your Pharmacist about non-steroidal anti-inflammatory (NSAID) medication such as ibuprofen to help relieve pain
4. Your Pharmacy may stock a range of herbal tablets, capsules or liquids that help to reduce the swelling associated with Gout by removing excess fluid from the body (diuretics) e.g., celery, juniper.
5. Keep the bodyweight within normal range. Gout is often associated with obesity. Ask your Pharmacist for help if you need to reduce weight.
6. Avoid alcohol, especially beer. Alcoholic beverages are unsuitable for Gout sufferers as they decrease the excretion of uric acid from the kidneys.
7. Avoid aspirin as it may aggravate the condition.
8. If the diet is inadequate, consider taking some nutritional supplements. 500mg of vitamin C daily has been shown to help reduce uric acid levels in the blood