Saturday, March 19, 2016

Gout has started to affect growing numbers of young people – but what can we do about it?

Source Website: http://www.mirror.co.uk/lifestyle/health/gout-started-affect-growing-numbers-5681926
By Michele O'Connor, 12 May 2015 at 00:02


Painful: More and more young people are coming down with gout
PHOTO: Painful: More and more young people are coming down with gout
Picture posted by Michele O'Connor on 12 May 2015 at 00:02
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The so-called disease of kings is a form of inflammatory arthritis that now afflicts one in 40 of us, with cases doubling over the past 10 years It’s dubbed the disease of kings – Henry VIII was a sufferer – because it’s associated with older, portly men who drink too much and gorge on rich food.

But gout is no joke. It affects one in 40 people in the UK – and patients are getting younger, experts warn.

In fact, NHS figures reveal numbers have doubled in the last 10 years. And, since 2012, hospital appointments for those in their 20s and 30s have increased by 30%.

Michele O’Connor looks at the reasons why and what can be done...

What is gout?
It is a type of arthritis caused by a build-up of uric acid (urate) in the blood. Urate is normally a harmless waste product, produced when the body breaks down substances known as purines, found naturally in the body and in certain foods and alcohol.

Crystals of urate can form inside joints causing sudden and severe pain.


Historic case: King Henry VIII was a famous sufferer of 'the disease of kings'
PHOTO: Historic case: King Henry VIII was a famous sufferer of 'the disease of kings'
Picture posted by  Michele O'Connor, 12 May 2015 at 00:02
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“It’s the most common ­inflammatory arthritis in men and, left untreated, can damage the joints,” says Dr Kelsey Jordan of the UK Gout Society.

“But it’s also the only curable form of arthritis. Around 80-90% of patients classically present with an attack in the big toe joint, although older women may have symptoms in the finger joints.


Around 80-90% of patients classically present with an attack in the big toe joint, although older women may have symptoms in the finger joints.
PHOTO: Around 80-90% of patients classically present with an attack in the big toe joint, although older women may have symptoms in the finger joints.
Picture by tumblr - Neve Campbell's feet & toes
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“The joint will be excruciatingly painful, red, hot and inflamed.”

Why are more of us suffering from it?
“It’s partly due to better ­awareness,” says Dr Jordan. “The pain is so acute, men who wouldn’t normally see a GP get help as they think they’ve broken a toe! The main reason, however, is an older population and the rise in obesity and Type 2 diabetes.

“Drug treatments for heart disease and hypertension also play a role. Low dose aspirin and diuretics can increase urate levels increasing the risk.”

But it’s a myth you have to be a big drinker to get it. Recent research shows that alcohol plays a smaller role than previously thought.


Inflammation: An illustration of gout in the big toe
PHOTO: Inflammation: An illustration of gout in the big toe
Picture posted by  Michele O'Connor, 12 May 2015 at 00:02
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How is it managed?
Treat the symptoms of an acute attack and then take medication to prevent further attacks, explains Dr Jordan.

Your GP will prescribe a course of anti-inflammatory drugs or, ­sometimes, colchicine – which works by reducing the ability of the urate crystals to inflame the joint lining (synovium).

For severe gout, ­corticosteroids may be prescribed. Patients suffering repeat attacks should see a ­rheumatologist who will usually give a steroid injection into the joint as this is the quickest way to alleviate the problem.

Your doctor should also assess risk factors such as Type 2 diabetes, high blood pressure and high cholesterol, adds Dr Jordan.

Patients are advised to rest, raise the affected limb and avoid knocking the joint. An ice pack can help and they should drink plenty of water.


Doctors say there is a link to diabetes
PHOTO: Other risks: Doctors say there is a link to diabetes
Picture posted by  Michele O'Connor, 12 May 2015 at 00:02
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Urate-lowering medication is then prescribed as a long-term treatment. “Allopurinol is the first choice because it’s safe and well tolerated,” says Dr Jordan.

Febuxostat is an alternative, and a newer drug, lesinurad, is still awaiting NICE approval.

“Patients should be told the problem may feel like it’s getting worse before it gets better,” advises Dr Jordan.

Because the treatment mobilises the uric crystals as it tries to dissolve them, it can sometimes cause a ‘flare’.

“If patients aren’t warned, they may simply stop taking their medication,” adds Dr Jordan.

Urate levels need checking a month after diagnosis so treatment can be altered if needs be.

Most patients are cured in 12-18 months, but need to stay on ­treatment for life to avoid repeat attacks.

How you can help ward off the condition
Change your diet:
Some foods – and beer – are high in natural compounds (purines) which can trigger gout.

Avoid offal (liver and kidneys, heart and sweetbreads), game (rabbit, pheasant and venison - meat from a deer), oily fish, seafood and foods or ­supplements that contain yeast or meat extract (Marmite, Bovril and commercial gravy and beer), and stout too.


Stout on the list of food and drink containing purines
PHOTO: Risk: Stout on the list of food and drink containing purines
Picture posted by  Michele O'Connor, 12 May 2015 at 00:02
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Low-fat dairy foods appear to protect against gout as milk proteins raise the body’s ability to remove uric acid, says GP and author Dr Sarah Brewer.

“This is supported by a study in which uric acid levels increased in a group of people following a dairy-free diet for four weeks,” she says.

Dark blue and red fruits such as cherries, blueberries and bilberries contain antioxidants which can lower uric acid levels too.

US researchers found patients with gout who ate ­cherries over two days had a 35% lower risk in attacks compared to those who didn’t eat them. Try Cherry Good juice (£1.50, leading supermarkets).

Lose weight:
Being lighter and exercising more will help reduce your uric acid levels significantly. And a daily 500mg vitamin C supplement can cut your risk by increasing the amount of uric acid excreted in urine.


Lose weight:can help to ward off the gout condition.
PHOTO: A daily 500mg vitamin C supplement can cut your risk by increasing the amount of uric acid excreted in urine.
Picture posted by Michele O'Connor on 12 May 2015 at 00:02
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By Michele O'Connor, 12 May 2015 at 00:02



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