Gout is a condition that conjures up some very particular images. Things like:
- rich foods
- excessive royal revelry
- those old cartoons by James Gillray (see above!)
Nowadays we know the roots of gout are much more complex. And also that they aren’t merely confined to historic gluttons like Henry VIII. In fact the number of people being diagnosed with the condition has surged in recent years, even amongst the younger generations.
Gout is something we also see quite often here in the clinic – in our case, of course, in the knee joints. So how would you know if it was affecting your own knees? And what might be causing it?
What is gout?
Gout is a type of inflammatory arthritis (not to be confused with wear-and-tear arthritis). It happens when tiny urate crystals accumulate on the surfaces of joint tissue. When these crystals spread into the protective synovium between bones, they can rub against the tissues, causing inflammation and serious pain. Toes and ankles tend to be the first joints affected, but gout can start in the knees too.
What would it look like in a knee?
A knee with gout will usually be hot, red and swollen. It may be very tender or extremely painful to touch or move. It tends to come on suddenly, often starting in the early morning and reaching its worst point within 24 hours. Because these symptoms can also be signs of an infection, it’s very important to seek medical advice to rule this out – especially if you start to feel ill.
How would I know for definite that it’s gout?
Diagnosing gout starts with an examination and asking about your medical history. We might then arrange a blood test to determine your urate levels (though a high urate level doesn’t necessarily lead to gout). Imaging like ultrasound and CT scans can be helpful too. Finally, we can also arrange to take a sample of fluid from your joint (it’s done with a needle) so the crystals can be identified under a microscope.
What might be causing my gout?
You’re probably wondering what causes the urate crystals to form in the first place. Urate is an acid that’s created when the body breaks down purine molecules, some of which come from food and drink. Our bodies dispose of excess purine through the kidneys. But if the resulting uric acid builds up and remains high, it can start to form those crystals.
Does diet contribute to gout?
To an extent. If you have elevated levels of uric acid, it may be wise to exercise caution over foods with high levels of purines. The NHS highlights red meat, offal (such as kidney and liver) and seafood as three particular types of food that increase the chances of getting gout. Excessive beer and spirits are also a bad idea (beer particularly, because it contains a lot of purines). Being overweight is also a high-risk factor in developing gout. That said, diet isn’t the only game in town in this regard. Other risk factors include kidney disease, high blood pressure, certain kinds of medication, and a family history of gout. Men are also about four times more likely to get gout than women.
What can I do about it?
The good news is that gout is now very treatable. There are several medicines that can be deployed when it strikes – the main ones are colchicine and non-steroidal anti-inflammatory drugs (NSAIDs). A longer-term preventative medicine is allopurinol, which works by lowering the level of uric acid in the blood. We sometimes also recommend a steroid injection to the knee joint, or aspiration (removing fluid around the joint) to relieve swelling and pressure.
Lifestyle changes can make a difference too. The NHS has a useful list of recommendations for preventing gout from recurring:
- get to a healthy weight, but avoid crash diets – try the NHS weight loss plan
- eat a healthy, balanced diet – your doctor may give you a list of foods to include or limit
- have some alcohol-free days each week
- drink plenty of fluids to avoid getting dehydrated
- exercise regularly – but avoid intense exercise or putting lots of pressure on joints
- stop smoking
- ask a GP about vitamin C supplements*
Are you suffering from gout, or wondering if you might be? Please feel free to get in touch with us to book an appointment. We can investigate what’s going on and make sure you get the appropriate treatment plan.