UPDATED: 19:30 EST, 4 February 2013 The thing that really makes postman Neil Pertas blood boil would be the sniggers and jokes his gout provokes. Neil has suffered from gout for 12 years, and a year ago had to move to a desk job because he canat stand on his toes for longer than one hour without pain. aIam crippled by it, and had to have 90 days off work since the pain was so agonizing. 'My GP's attitude appears to be it is all self-inflicted, although I have not had alcohol or enjoyed rich meals for years,' said Neil Pert 'My legs and legs are specially poorly affected, and when Iam having a strike I canat bear any weight on them,a says 44-year-old Neil, who lives in Clydebank, Glasgow, together with his wife Jennifer, 46, an associate shop manager, and their daughter Hannah, 11. aYet Iam often teased about my gout. 'My GPas attitude appears to be that itas all self-inflicted, even though I havenat had alcohol or eaten rich foods for years, while colleagues think I use it to have out of work.a A spotlight was thrown on critical gout recently following the story after his hand was paralysed following a attack that had generated disease that a hand transplant was undergone by Mark Cahill, a former publican Yorkshire. Though such situations are luckily rare, doctors say they are seeing increasing amounts of patients with extreme gout and joint injury. Hospital admissions have doubled in ten years to 4,400 cases per year, based on a recently available review of GP practice files. But experts say a lot of the miseryA of gout is completely preventable a' with the best treatment. Gout is just a kind of arthritis that causes immediate and very severe attacks of pain and swelling in the bones. Itas caused by extortionate levels of uric acid in the body, which forms needle-like crystals in and around the joints, mostly in the foot (particularly the big toe), but also the hips, hands, forearms and arms. Since the body temperature there's slightly cooler (crystals grow at lower temperatures), the crystals form in the extremities. Uric acid also collects in the kidneys, forming kidney stones. Uric acid is just a chemical made if the human anatomy breaks down purines (compounds within certain foods including red meat). Itas usually excreted by the kidneys, but some people donat clear it as well. High degrees of purines will also be connected to a diet, or as a side-effect of treatments such as diuretics prescribed for high blood pressure. Gout is a kind of arthritis that creates immediate and very serious attacks of pain and swelling in the joints Other risk facets include obesity (partly due to additional stress on the joints and chemical changes as a result of the fat), and heavy alcohol use, particularly alcohol (which can be full of purines). It usually first appears involving the ages of 30 to 60 and becomes more widespread with age, influencing 7aaper cent of men over 85 and 3aaper cent of women. therefore gout is less common in pre- menopausal women.), (The hormone oestrogen speeds up the excretion of uric acid Around 800,000 Britons have gout, but the number is growing because of obesity, our diet and the ageing population. aItas now the most common chronic inflammatory rheumatic condition a more common than even rheumatoid arthritis,a says George Nuki, of the UK Gout Society and professor emeritus of rheumatology at Edinburgh University. aAlthough goutas results can be extremely severe a' as serious as the worst deformities caused by rheumatoid arthritis a' it certainly ought to be both preventable and treatable by the medical remedies now available.a Medication is meant by this, combined with basic changes in lifestyle and avoiding purine-rich foods. aIt is so annoying as it can be done to cut back uric acid to such low levels that the crystals melt, but regrettably not enough people are receiving effective treatment,a says Professor Nuki. aGout is largely handled generally practice, and Iam scared it isnat being done very well. aThere is insufficient knowledge among both health practitioners and patients concerning the significance of reducing the crystals levels and keeping them at a low level.a The danger of untreated or undercontrolled gout is joint harm caused when the deposits heap together, forming a chalky substance called tophi.Tophi in many cases are painless at first, nevertheless they can be quietly damaging the joint. Some individuals create tophi and joint injury without actually experiencing an acute gout attack. Eventually, the damage severely limits activity, affecting walking and the usage of the hand. A damaged joint is also more vulnerable to disease. The main drug for stopping gout is allopurinol, which prevents the enzyme that converts purines in to uric acid. GPs are supposed to start patients off on a dose and then gradually adjust it upwards until blood tests show uric acid levels are paid down enough so the crystals dissolve, and new crystals end forming. aBut research has shown that significantly less than 10 % of people receive the follow-up blood tests, so many individuals remain on the low amount that doesn't reduce their uric acid levels sufficiently and deposits continue to increase and can damage their joints,a says Professor Nuki. Sometimes, also, gout patients stop using the allopurinol since they feel a lot better, despite the fact that crystals can nevertheless be growing. Or they stop taking it because of the drugas side-effects (such as skin rashes), or because the drug can occasionally initially make gout worse before then increasing symptoms. In these instances you can find, in fact, solutions a febuxostat and benzbromarone. The problems are highlighted by neil Pertas story with gout therapy. When Neilas first signs appeared 13 years ago, his GP said he could possibly be approved allopurinol, or try to tackle his uric acid levels by changing his lifestyle. aThe GP mentioned the side-effects of allopurionl could be anastya and that put me off it,a recalls Neil. aAt enough time I weighed 22st (Iam 5ft 11in) and drank pretty heavily, so I decided instead to test a low-purine diet and stop trying liquor for good.a Neil lost six stone and his healthy lifestyle has made his severe gout attacks less frequent. But, the low-level pain in his feet, legs, arms and fingers has worsened, and heas now in pain every day. He hopes now to visit a specialist. aPerhaps I do need drug therapy as well, after all,a he concedes. ukgoutsociety.org
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