Your Health A-Z


Gout – not just a pain in the toe

Gout is the most common inflammatory arthritis in the world and was one of the first medical conditions ever to be described – by the Egyptians in the 2nd century BC. The condition has always been associated with an affluent diet and was called the ‘disease of kings’. Gout causes pain and swelling in affected joints, and if left untreated can cause irreversible damage.

What exactly is gout?
Dr Gareth Tarr, rheumatologist and specialist physician at the Winelands Rheumatology Centre in Stellenbosch: ‘An attack of gout is characterised by a tender, swollen, red joint and reaches peak intensity within 12-24 hours, often beginning in the big toe.’ However, the pain-causing crystals can also deposit in other joints, the elbows and even the ears.

What causes the condition?
High levels of uric acid in the body, which is produced through the metabolism of certain foods, causes gout. Ironically 60% of patients with elevated uric acid levels will not develop gout. Prof Helmuth Reuter, head of the Winelands Rheumatology Centre says: ‘The cause of gout is strongly related to age, diet, metabolic syndrome (obesity, hypertension, high cholesterol and diabetes), chronic kidney impairment, certain drug treatments such as asprin, and there is a heritable component. Foods that affect gout include: meat, seafood, alcohol and fructose or fruit sugar. Trauma, surgery, dehydration and starvation can also be causes.’

Who is most susceptible?
Gout affects men and postmenopausal women, rarely occurring in men before adolescence or in women before menopause, and the prevalence rises with advancing age.

How do you treat gout?
Medicine to lower uric acid is used to prevent gout getting worse. Cortisone injections into the joint offer relief too. However, lifestyle changes are essential such as losing weight if obese, stopping smoking, exercising more and drinking plenty of water. Also avoid eating organ meats, high-fructose corn syrup-sweetened drinks and alcohol overuse. Limit portions of beef, pork, lamb, and reduce the quantity of salt, sugar, and sweetened fruit juices consumed. ‘We encourage low-fat dairy products, foods made with complex carbohydrates (whole grains, brown rice, oats, beans), vegetables, and limiting alcohol consumption,’ adds Prof Reuter.

Should you exercise when in pain?
Patients suffering from arthritis generally avoid exercise because of joint pain, and this lack of physical activity may lead to stiffness and muscle weakness. Dr Tarr emphasises it’s important to remember is that exercise can decrease pain and enhance quality of life. An arthritic exercise programme should aim to improve muscle strength and build endurance, and be performed on a regular basis.

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