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Gout

Gout is a very painful form of arthritis usually affecting only one joint at a time. It is caused by microscopic crystals of uric acid forming within the oily fluid of the joint, the so-called synovial fluid. Uric acid in turn comes from the metabolism of a food substance called purine. Foods high in purine are sea foods like mussels, oysters and herring and meats particularly offal like heart and liver. Yeast, as in beer for example, is also high in purine but not wine or port. It is an old wife’s tale that gout is a “rich man’s disease” or that it is caused by alcohol. It is not.

Gout does affect men three times more often than women however. Exactly why this should be is not understood. Attempts to control gout by diet alone are usually destined to fail. Blood uric acid levels can be controlled by a drug called Allopurinol and acute attacks of gout are best treated by high doses of steroids tapered down over a period of ten days. Gout does not generally respond to non-steroidal anti-inflammatories.

Although quite classical in its presentation gout can be confused with other forms of arthritis such as Polymyalgia Rheumatica. Here are the salient features that separate these two conditions:

  • Gout usually only affects one joint at a time, typically that of the big toe, knee or wrist. Polymyalgia Rheumatica on the other hand affects the shoulders, back and thigh.
  • Gout has a sudden onset and usually establishes itself within 24 hours. Polymyalgia on the other hand is of gradual onset taking days or weeks to set in before medical attention is sought.
  • Gout is exquisitely painful, particularly to touch. In fact it is this feature that makes gout so easy to diagnose. Tenderness I, as we say pathopneumonic of this disease. Polymyalgia Rheumatica on the other hand is disabling but does not have anything like the intensity of pain.
  • Gout is three times commoner in men than in women. Polymyalgia Rheumatica is the exact opposite; it is three times commoner in women than in men.
  • There is a definitive blood test for gout and that is a raised uric acid level. With Polymyalgia Rheumatica there is no such definitive blood test.

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