Why are the gout flare-ups in my toe worse in summer?

GETTING TO THE HEART OF MEDICAL MATTERS

- Dr Rosemary Leonard

Q I've had gout for years and despite taking 600mg allopurinol, I still get really painful flareups in my big toe, which have been particularly bad this summer. Should I increase the dose of allopurinol or are there any better alternatives?

Gout is caused by raised levels of uric acid in the blood. Uric acid is normally harmless, and any excess is passed out in the urine. However, in people with gout, the levels rise and tiny crystals of it may form and collect in joints, leading to inflammation, swelling and often severe pain - a gout attack.

The most common reason for the rise in the level is that the kidneys do not pass out enough uric acid, but there may be additional factors that can cause a rise, such as drinking too much alcohol or taking some medicines, such as diuretic (water) tablets, aspirin, or some chemotherapy agents.

Gout affects about one in 50 adults, mostly men, and typically starts in middle age. It can occur in any joint, but especially in the first attack the base of the big toe is most commonly affected, making it difficult to wear shoes or to walk.

Some only get very occasional attacks of gout and go months or even years before another one occurs, but others, like you, get attacks more frequently. The best way of preventing recurrent attacks is with a combination of medication and lifestyle measures.