What is gout?
Gout affects about 4% of the UK population. It’s a condition that usually affects men. It causes short lived ‘attacks’ of very intense pain, which affect the lower limbs, especially the big toe joint, but it can also affect the mid-foot, the ankle and the knees.
Gout can mean unbelievable pain for the patient – pain that can last anything from a couple of days to a couple of weeks and it’s often recurrent. Gout can cause long-term severe and irreversible damage to joints and kidneys and is associated with an increased risk of heart attack.
When we see a patient with suspected gout, we’re looking to confirm the diagnosis. This is usually done by taking a thorough history and performing a physical examination to look at the affected joints. We will then try to decide, with blood tests, if it’s primary or secondary gout.
There is often a family history of gout. Blood tests, X-Rays or imaging can be performed at your first appointment.
We can give you treatment on the same day that will get rid of your pain, too. If you’re someone who experiences ‘excruciating pain, exacerbated by even the bedclothes touching the joint’ and someone says they can take that pain away for you today, that’s a very reassuring and helpful thing!
In 100% of cases, we can get rid of gout pain on the same day. We’ll then decide on a longer-term management plan. Certain foods can precipitate the condition, so we may give you information about diet and lifestyle.
We’ll listen to your history, perform a physical examination and arrange blood tests and an X-Ray.
A steroid injection on the same day, or some tablets, will get rid of your pain. You will then be followed up a couple of weeks later to make sure the pain has gone and to allow us to create a longer-term management plan. We can make sure there are no secondary causes of gout and you are happy with your treatment plan.
There are drugs that can get rid of the condition and there are also drugs that lower uric acid in the blood, which can prevent it coming back.
Often gout symptoms can be sorted out with a couple of appointments. There’s treatment for an acute attack of gout and then there’s treatment to prevent it. It’s important not to take the preventative treatment when you’ve got acute gout, as it can make it much worse.
When you have been started on treatment to keep gout away, we now adopt a ‘Treat to Target’ approach. We aim to lower your uric acid to below 300umol/L to prevent joint and kidney damage. We will recommend a blood test to check the level of uric acid at three months and perhaps again at six months, if the dose of the drug to lower your uric acid needs to be increased. In the longer term, most patients remain on a single agent, which prevents any further attacks of gout for the long term.