Gout

What is Gout?

Gout is incredibly common, affecting 1.4% of the population. It is 3 times more prevalent than rheumatoid arthritis.
Gout occurs when the body produces high levels of uric acid (urate) due to a condition called hyperuricemia. This leads to the formation and deposition of urate monosodium crystals within soft tissues. This results in what we know as Gout.

An episode of gout is triggered when serum urate concentration levels surpass 8.0mg/dL.
Tausche et al (2009)

What causes Gout?

Gout is a systemic rheumatological disease. Little is known about the exact cause of gout, however there are many associated risk factors. These include;

• Gender. Men are up to 9 times more susceptible to Gout. Pre-menopausal women are protected from gout by the hormone, oestrogen.
• A diet rich in purine such as red meat, wild game (Veal and dark) and offal.
• High levels of alcohol consumption (both beer and wine have been implicated)
• Increasing age
• Obesity
• Kidney failure
• Some prescription medications i.e. Thiazide
• Hereditary uric acid disorder however, this is relatively rare.

A Gout attack is typically triggered by a sudden increase in rich food or after consuming alcohol. An attack usually starts with acute pain in a single joint (often the big toe). In most cases, Gout will resolve by itself within a week. Unfortunately, if you suffer from an attack of Gout you have a 90% chance of further attacks over the subsequent 5 years.

How is Gout diagnosed?

Gout is usually diagnosed via your G.P who will ask you a series of questions to uncover any possible causes of the attack (such as a big night out or a change in diet). Your doctor will request blood tests to assess urate serum levels. The most accurate urate serum levels are typically taken 2 to 3 weeks after the attack as often during the attack serum levels remain stable.

Diagnostic musculoskeletal ultrasound has been shown to be a safe and highly effective tool for diagnosing Gout. It has been shown to be highly sensitive at uncovering bony erosions caused by inflammatory arthritic conditions including gout (Fernandez at et. 2017 and Villaverde et al. 2014).
At Complete all our clinicians are fully qualified musculoskeletal sonographers who are experienced in assessing this condition.

How do you treat my Gout?

Medication

Immediate treatment is focused on reducing the acute episode of pain associated with a Gout attack. Your G.P will often prescribe you a nonsteroidal anti-inflammatory medication such as Naproxen, often with a gastric protector drug such as Omeprazole.

If you suffer from Gout regularly your G.P may prescribe a long-term urate-lowering medication such as Allopurinol.

Lifestyle

Long-term management requires lifestyle modification. A healthy diet, reduced alcohol consumption and weight loss will dramatically reduce the chance of further episodes of Gout.

Ultrasound guided injection

An ultrasound-guided steroid injection can be used to reduce the pain and inflammation present during an acute episode of Gout. A corticosteroid is a powerful anti-inflammatory medication that can be deposited within the affected joint. Ultrasound imaging can be used to locate and guide the placement of the medication directly at the epicentre of the Gout. The current evidence base states that ultrasound-guided steroid injections are more effective and more accurate than landmarked injections.

At Complete all our clinicians are highly experienced musculoskeletal sonographers who are able to perform guided injections. Complete run a same-day service with all ultrasound-guided injections. You do not need to be referred by your G.P. All our clinicians are able to fully assess you, perform a diagnostic ultrasound scan, prescribe and carry out an injection in the same appointment.

For further information or to book an appointment please contact Complete on 0207 4823875 or email injections@complete-physio.co.uk.