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Most people don’t realise that gout is the most common form of inflammatory arthritis in the world. According to the Global Burden of Disease Study 2020, there are 55.8 million adults with gout worldwide; that’s more than twice the number of people living with rheumatoid arthritis.

Gout is characterised by repeated attacks of extreme joint pain, swelling and redness. The most commonly affected joint is the big toe, but gout can affect your feet, ankles, knees, elbows, wrists and fingers.

Historical stereotypes

Gout has always gotten a bad rap. It’s long been associated with kings, lavish living and overindulgence of food and alcohol.

We now know this isn’t the case. It’s a complex, very painful condition that affects many Australians, who deal with stigma based on an out-of-date stereotype.

Women get gout too, as do people who don’t drink or eat meat. Gout is more complex than the historical image. Which is why some rheumatologists have suggested gout be renamed ‘urate crystal arthritis’ to lose the stigma attached to ‘gout’.

So what does cause gout?

Gout occurs when uric acid, a normal waste product, builds up in the bloodstream and forms urate crystals in a joint.

Our body makes uric acid when it breaks down purines, a substance found in our cells and in food.

Uric acid normally dissolves in your blood, is processed by your kidneys and leaves your body in urine.

If your body makes too much uric acid, or your kidneys can’t clear enough of it out, it builds up in your blood. This is called hyperuricemia (pronounced hy-per-uri-cemia).

Having hyperuricaemia doesn’t mean you’ll develop gout. In fact most people with hyperuricaemia don’t go on to develop gout. Because of this it’s thought that other factors such as your genes may be involved.

Find out more about gout, including what you can do in terms of your diet and weight.

Call our Helpline

If you have questions about things like managing your pain, your musculoskeletal condition, treatment options, or accessing services be sure to call our team. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@muscha.org) or via Messenger.


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We get asked this question a lot! But unfortunately, it’s not a simple ‘yes’ or ‘no’ answer.

Arthritis is a general term used to describe over 150 different conditions. The more accurate name for them is musculoskeletal conditions, as they affect the muscles, bones and/or joints.

They include osteoarthritis, back pain, rheumatoid arthritis, fibromyalgia, gout, polymyalgia rheumatica, lupus, osteoporosis and ankylosing spondylitis.

Around 7 million Australians live with a musculoskeletal condition, including kids. So can you avoid becoming one of them?

Maybe? Not really? It depends? 🙄

Because there are many different types of musculoskeletal conditions, the answer depends on various factors.

For conditions like rheumatoid arthritis, juvenile arthritis, ankylosing spondylitis, and lupus, we don’t really know their cause. Without knowing the cause, it’s hard to prevent something from occurring.

What we do know is that they’re autoimmune conditions. That means they occur due to a malfunctioning immune system. Instead of attacking germs and other foreign bodies, the immune system targets joints and healthy tissue, causing ongoing inflammation and pain. We don’t know why this happens, but scientists believe that a complex mix of genes and environmental factors is involved.

At this stage, we can’t change a person’s genetics to prevent them from developing an autoimmune type of arthritis, or conditions like osteoporosis and Paget’s disease, which are also linked to genetics. Many musculoskeletal conditions also become more common as you get older and are more common in women.

Other health issues, such as diabetes, kidney disease, coeliac disease, and even other musculoskeletal conditions 😫, can also increase your risk of developing a musculoskeletal condition. For example, chronic kidney disease can increase your chance of developing gout, and rheumatoid arthritis increases your risk of developing osteoporosis and fibromyalgia.

So that’s the bad news.

The good news is there are things you can do to reduce your risk of developing a musculoskeletal condition. Or, if you develop one, reduce its impact and severity.

Maintain a healthy weight

Excess body weight puts more pressure on your joints and increases the stress on cartilage, especially in weight-bearing joints like your hips, knees, and back. For every kilo of excess weight you carry, an additional load of 4kgs is put on your knee joints.

In addition to putting added stress on joints, fat releases molecules that increase inflammation throughout your body, including your joints. Being at a healthy weight reduces this risk.

Being overweight or obese is strongly linked to developing osteoarthritis (OA), most often in the knees. Hand OA is also more common in people who are overweight.

Back pain and inflammatory conditions such as gout, rheumatoid arthritis, and psoriatic arthritis have also been linked to being overweight.

If you have a musculoskeletal condition, maintaining a healthy weight, or losing weight if you’re overweight, can decrease your pain, allow you to become more active, and decrease your risk of developing other health problems like heart disease and diabetes.

Quit smoking

As well as the obvious links to cancer and lung disease, smoking’s linked to back pain, neck pain, rheumatoid arthritis and osteoporosis. Smoking also causes fatigue and slower healing, which can make pain worse. And it can make some medications less effective.

So quitting smoking has many health benefits. Within weeks of quitting, you’ll breathe easier and have more energy, making it easier to exercise and do your day-to-day activities. Find out more about the impact of smoking and ways to quit for good.

Stay active and exercise regularly

Regular exercise is vital for overall good health and keeps you fit, independent and mobile. Being active helps keep your muscles, bones and joints strong so that you can keep moving. It reduces your risk of developing other conditions such as osteoporosis, heart disease, diabetes and some forms of cancer. It boosts your mood, benefits your mental health, helps with weight control and improves sleep.

Having strong muscles is also essential to reduce your risk of falls.

Look after your mental health

Mental health conditions can increase the likelihood of developing some musculoskeletal conditions. For example, people with depression are at greater risk of developing chronic back pain. And living with a painful musculoskeletal condition can have a significant impact on mental health.

If you’re living with anxiety, depression, or another mental health condition and feel that you’re not coping well, it’s important to seek help as soon as possible. This will ensure you don’t prolong your illness and worsen your symptoms. It becomes harder and harder to climb out of a depressive episode the longer you wait. Similarly, the longer you put off seeking help for anxiety, the more anxious you may become about taking that first step.

There are many different types of treatment options available for mental health conditions. The important thing is to find the right treatment and health professional that works for you. With the proper treatment and support, they can be managed effectively.

Get enough calcium and vitamin D

Calcium and vitamin D are essential to building strong, dense bones when you’re young and keeping them strong and healthy as you age.

Getting enough calcium each day will reduce your risk of bone loss, low bone density, and osteoporosis.

Calcium is found in many foods, including dairy foods, sardines and salmon, almonds, tofu, baked beans, and green leafy vegetables.

Vitamin D is also essential for strong bones, muscles and overall health. The sun is the best natural source of vitamin D, but it can be found in some foods.
If you’re unable to get enough calcium or vitamin D through your diet or safe sun exposure, talk about calcium and/or vitamin D supplements with your doctor.

Protect your joints

Joint injuries increase your risk of getting OA. People who’ve injured a joint, perhaps while playing a sport, are more likely to eventually develop arthritis in that joint. So it’s important to protect against injury by:

  • maintaining good muscle strength
  • warming up and cooling down whenever you exercise or play sport
  • using larger, stronger joints or parts of the body for activities, for example, carrying heavy shopping bags on your forearms, rather than the small joints in your fingers
  • using proper technique when exercising, for example, when using weights at the gym or when playing sports, especially those that involve repetitive motions such as tennis or golf
  • maintaining a healthy weight
  • avoiding staying in one position for extended periods
  • seeking medical care quickly if you injure a joint.

Drink alcohol in moderation

Excessive alcohol consumption contributes to bone loss and weakened bones, increasing your risk of osteoporosis. For people with gout, drinking too much alcohol, especially beer, can increase your risk of a painful attack.

It can also affect your sleep, interact with medicines, and affect your mental health. To find out more about the risks of drinking too much alcohol and how you can reduce your alcohol intake, read ‘Should I take a break from booze?’.

Manage stress

While stress on its own is unlikely to cause someone to develop a musculoskeletal condition, chronic stress or a stressful event may be a contributing factor, especially with conditions such as fibromyalgia and back pain.

It can also cause issues with sleep, mood, increase pain, and make you more prone to flares if you have a musculoskeletal condition. It can then become a cycle of stress, poor sleep, pain and more stress. And this can be a difficult cycle to break.

But there are things you can do to deal with stress. Try relaxation techniques such as meditation, breathing exercises and visualisation, and avoid caffeine, alcohol and cigarettes.

Talk to someone – whether it’s a family member, friend or mental health professional, about what’s stressing you out so you can deal with it.

Talk with your doctor

If you’ve been experiencing joint or muscle pain, it’s important that you discuss your symptoms with your doctor. Getting a diagnosis as soon as possible means that treatment can start quickly, reducing the risk of joint damage and other complications.

Final word

While at this moment in time, we can’t absolutely 100% prevent ourselves from getting a musculoskeletal condition, the good news is that early diagnosis and treatment will give you the best outcomes.

Treatments for many of these conditions have come a long way in recent years, and most people live busy, active lives with musculoskeletal conditions. 😊

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04/May/2022

Did you know that some forms of arthritis are caused by crystals forming inside a joint?

Two of these conditions are gout and acute calcium pyrophosphate (CPP) crystal arthritis. CPP is a mouthful (!), but you may have heard of its old name, pseudogout, which means ‘false gout’.

So what are these conditions? And how do they affect people?

Let’s start with gout.

Gout is a common and painful form of inflammatory arthritis. It involves sudden flares of extreme joint pain, swelling and redness. It most often affects the big toe, but it can affect any joint, including your wrists, ankles, knees, elbows, and fingers.

Gout occurs more frequently and develops earlier in men, often between 30 and 45 years. Women are more at risk of developing gout after menopause. It affects both men and women equally over 65.

Gout occurs when uric acid builds up in your blood, causing needle-shaped crystals to form inside a joint.

Some things increase your risk of developing gout. They include:

  • being overweight or obese
  • having conditions such as high blood pressure, chronic kidney disease, diabetes and heart disease
  • drinking too much alcohol (especially beer)
  • eating a diet high in purines such as meat, sweetbreads, offal, shellfish, and fructose
  • using diuretics
  • becoming dehydrated
  • crash dieting, fasting or overeating.

Acute calcium pyrophosphate (CPP) crystal arthritis also involves sudden and painful flares of extreme joint pain, swelling and redness. This condition most often affects the knees and wrists but can affect other joints and tendons.

CPP affects both men and women, most commonly over age 60.

It occurs when calcium pyrophosphate crystals form in the joint cartilage. They may also be found in the joint lining and the joint fluid. Unlike the needle-shaped crystals in gout, these crystals are rod-shaped with blunt ends. It’s not clear why the crystals form, but they increase in number as people get older.

Some things increase your risk of developing CPP. They include:

Diagnosing crystal arthritis

Many conditions can cause joint pain and swelling, so your doctor will talk with you about your symptoms and medical history and examine the affected joint. If they suspect you have gout or CPP, they will take scans of the joint.

They may also remove a fluid sample from your joint. This fluid is examined under a microscope for the presence of crystals or anything else that may be causing the pain and inflammation. This is the most definitive test for crystal arthritis and indicates whether uric acid crystals or calcium pyrophosphate crystals are present.

Treatment

The first step in treating gout and CPP is to control the pain and inflammation. This may involve medicines, cold packs, and resting the joint.

Your doctor will consider your medical history and other health issues when deciding which medicines are most appropriate and safe for you to use.

The most common medicine used to control pain and inflammation during a gout or CPP flare is a non-steroidal anti-inflammatory (NSAID). Another common medicine used to treat gout is colchicine. Corticosteroids (or steroids) can also be very effective.

In the case of gout, once the flare is under control, your doctor may prescribe medicines that lower uric acid levels in your blood. This will depend on things such as:

  • how often you have flares
  • if you’ve developed tophi (hard, uric acid deposits under the skin) or kidney stones
  • other health conditions you may have (e.g. kidney disease).

For both conditions, treating any underlying conditions is also important to prevent future flares.

Self-care

As well as taking your medicines as prescribed, you can reduce the pain and swelling of a flare by using an ice pack on the painful joint for short periods. You should also protect and rest the joint.

Other things you can do to prevent future flares:

  • Take any medicines as prescribed.
  • Lose weight if you’re overweight or obese. This needs to be done carefully and gradually, as crash diets or fasting can cause a flare for people with gout. Your doctor and/or a dietitian can support you in this.
  • Drink water regularly, as becoming dehydrated can increase your risk of a flare for both conditions.
  • Drink alcohol in moderation and avoid binge drinking.
  • Eat a healthy, balanced diet. If you have gout, avoid or eat in moderation foods high in purines. Talk with a dietitian for more information. There is no link between CPP flares and diet. Although the crystals are calcium pyrophosphate, there’s no evidence having a calcium-rich diet triggers a CPP flare. In fact, everyone should ensure they get enough calcium in their diet to reduce their risk of developing osteoporosis.
  • Exercise regularly.
  • Work closely with your doctor to prevent further flares and actively manage your condition.

Contact our free national Help Line

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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We often associate gout with gluttony and enjoying too much alcohol. Historical images of gout include overweight, ruddy faced, aristocratic men or royalty such as Henry VIII.

But this isn’t the case and is too simplistic a view of a complex condition.

To find out more about gout, what causes it and how it’s treated, check out our gout info.

So what causes a gout attack?

If you have gout, you know that an attack happens suddenly, often overnight, and you’ll wake up in a lot of pain.

And it’s more likely to occur if you:

  • are male
  • have a family history of gout
  • are overweight
  • have high levels of uric acid in your blood
  • drink too much alcohol (especially beer)
  • eat a purine-rich diet (including foods such as red meat, offal, shellfish, fructose, beer)
  • use diuretics
  • become dehydrated
  • crash diet or fast.

Managing your weight

While you can’t control some of the risk factors to prevent a gout attack, you can control your weight. If you’re overweight, losing weight gradually and carefully can reduce your risk. However don’t go on a crash diet, skip meals or fast as this can also increase your risk of an attack.

If you need to lose weight, talking with your doctor and/or a dietitian is a really good idea to get the information and support you need to lose weight in a healthy way.

Other dietary changes

It’s believed that lowering uric acid levels through small changes in your diet may help reduce the chance of future gout attacks. These changes include:

  • restricting or avoiding alcohol
  • avoiding binge drinking
  • eating a healthy, well balanced, colourful diet. Research suggests that the DASH diet or Mediterranean diet may be helpful. Read our blog on anti-inflammatory diets for more info.
  • drinking plenty of water
  • avoiding fasting or crash dieting
  • making sure you don’t overeat on a regular basis.

Your doctor or dietitian can help guide you in making healthy changes to your diet.

Keep taking your medication

It’s important to note that dietary changes alone aren’t enough to address the underlying cause of gout – too much uric acid in your blood. For many years there’s been a misconception that simply changing your diet will help keep your gout under control.

However the research clearly shows that medication is needed for most people with gout to manage it effectively. So if you decide to make some dietary changes, discuss this with your doctor and continue to take any medication you’ve been prescribed to manage your gout.

Final word

Gout is a painful, complex condition that affects many Australians. But there are things you can do to take control, including managing your weight, making changes to the things you eat and drink and taking your medication.

Contact our Helpline

If you have questions about things like managing your pain, your musculoskeletal condition, treatment options, telehealth, or accessing services be sure to call our team. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@muscha.org) or via Messenger.

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30/Jul/2020

Looking after your feet

Our feet are amazing ‘feats’ of engineering (sorry, I just couldn’t resist that one).

Each foot has 26 bones, 33 joints, and more than 100 tendons, muscles, and ligaments. They support us through thick and thin – whether we’re walking, running, jumping, dancing, skipping or hopping. We cram them into ill-fitting shoes, torture them in high heels and stub them against the bedside table in the middle of the night (or is that just me?).

As well as the many injuries and calamities that befall our feet, many musculoskeletal conditions, such as osteoarthritis, rheumatoid arthritis and gout can affect the feet.

They’re the unsung heroes of this pandemic as we hit the streets, parks and trails for exercise. Walking has become the exercise of choice for people at the moment. Many of us can’t – or don’t feel safe to – return to gyms or exercises classes. And lots of people are walking instead of catching public transport to avoid being in close contact with others. As a result we’re all walking many more steps than we did pre-COVID.

So we need to stop taking our feet for granted. We need to look after them so we can continue to do the things we want and need to do as pain-free as possible.

So what can we do?

Give your feet the TLC they deserve. It’s really important to look after your feet. Wash and dry them regularly. Inspect them for anything unusual such as cuts, blisters, changes to the nails and skin. By being aware of your feet and any changes that occur, you can seek advice sooner. And if they’re sore after a day of walking, maybe give them a warm soak in the bath, or in a bucket or a foot spa (if you have one) while you watch TV. Then dry them thoroughly and rub a moisturising foot cream into your skin. Take your time and give your feet a nice massage. Better yet, see if you can talk someone else into giving them a massage while you relax on the couch.

Manage your condition. If you have a musculoskeletal condition that affects your feet, it’s important that you work with your doctor and healthcare team to look after your feet and manage your condition effectively. The treatments used for foot conditions will vary from person to person, depending on your condition and how it’s affecting you. And this may change over time as your condition and your feet change.

See a podiatrist. If you have foot pain, or a condition that affects your feet, visit a podiatrist. They’re feet experts and can assess, diagnose and treat foot and lower limb problem, including skin and nail problems, foot and ankle injuries, foot complications related to medical conditions and problems with your gait or walking. Podiatrists can also give you advice on appropriate footwear, and can prescribe custom foot orthotics.

Consider orthotics. Orthotics are corrective insoles that can help alleviate pain by redistributing pressure away from the painful area and support your arches. You can buy off-the-shelf orthotics or you can have orthotics made that are specifically fitted to your feet by a podiatrist.

Fit your feet with appropriate footwear. With our worlds turned upside down due to COVID, and many of us having to stay home, it’s tempting to stay in our slippers all day. There’s something so comforting about warm, fluffy slippers. However our feet and ankles need proper support. Wear the right footwear for whatever you’re doing. Going for a walk? Put on your sneakers. Working at home? Wear your casual shoes/boots that support your feet and keep you warm. And lounging around in the evening? Get those slippers on.

If you’re buying new shoes, make sure they fit properly, support your feet and are comfortable. Look for shoes that are light, flexible at the toe joints and are hard wearing. Shoes made of leather are preferable over synthetic materials as they breathe better. Avoid slip-on shoes and if laces are difficult to fasten due to arthritis in your hands, Velcro or elastic laces may be an option.

Let them breathe. Did you know you have about 250,000 sweat glands in each foot? That’s a lot of sweat! So let your feet breathe to avoid smelly feet and fungal infections. Change your socks and shoes at least once a day. Wear shoes that allow air flow around your feet: leather, canvas, and mesh are good options, avoid nylon and plastic. And avoid wearing the same shoes two days in a row. Give your shoes time (at least a day) to dry and air out. And if the weather’s warm, set your feet free and let them go au naturale. There’s nothing better than walking barefoot on warm grass on a sunny day.

Exercise your feet. I’m not talking about walking here…but other exercises that keep your joints moving. Try non-weight-bearing exercises such as swimming, especially if you have foot pain, as they take the pressure away from the painful areas. You can also do exercises while sitting in a chair. NHS Inform (Scotland) has some foot exercise videos you can try. If you want exercises tailored specifically for you, visit a podiatrist or physiotherapist.

Medications might help. If you’re having a lot of foot pain, speak with your doctor about whether medications may be an option. Depending on the underlying condition causing the problem, your doctor may prescribe a short-term course of pain relievers or anti-inflammatory medications, or they may prescribe other medications, such as a cortisone injection into a joint for rheumatoid arthritis or medication for acute attacks of gout.

Diabetes and feet. Many people with musculoskeletal conditions also have diabetes. So it’s really important if you have diabetes that you take care of your feet every day because of the increased risk of developing nerve damage, ulcers and infections. Talk with doctor about how to look after your feet properly if you have diabetes.

Surgery may be required. For some people, surgery may be needed if other conservative treatments haven’t helped. A referral to an orthopaedic surgeon who specialises in feet is usually required.

Contact our free national Help Line

If you have questions about things like managing your pain, COVID-19, your musculoskeletal condition, treatment options, telehealth or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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Musculoskeletal Health Australia (or MHA) is the consumer organisation working with, and advocating on behalf of, people with arthritis, osteoporosis, back pain, gout and over 150 other musculoskeletal conditions.

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