advice the doctor Whether its a health niggle, emotional problem or youre just looking for guidance, Inspire magazines Dr Sarah Jarvis gets straight to the point My husband suffers very badly from gout, which is brought on by the medication he is taking for his heart. He has tablets to try to help the gout, but when it is really bad, he can hardly put his foot to the floor, owing to the pain and it being swollen. We have tried different diets, but nothing seems to work. Do you have any advice? Name witheld, via email I was diagnosed with osteoarthritis at the age of 45. I had one knee replacement and the other has been cleaned out twice. It looks as if it will be another two years before I qualify for replacement for the other knee, and I have pains in lots of other joints. Im now 51 and on medication for depression but Im still really depressed and tired. What can I do? Name witheld, via email Do you a probl have like an em youd s so, wri wered? If Inspire te to us at: magaz 275 Ne wmark ine, Cambr e idge CB t Road, 5 8JE, or ema arthrit il inspire@ iscare. org.uk Dr Sarah Jarvis answers: Gout is a kind of arthritis, although the symptoms it causes tend to be very different from those of other types of arthritis, such as osteoarthritis and rheumatoid arthritis. Its common about 1 in 200 adults gets at least one attack in a lifetime and its more common in men than women. It also tends to run in families. Its caused by a chemical called uric acid, which is present in everyones blood but which causes problems if levels get too high. Most people pass enough uric acid naturally out of their systems (via the kidneys and, to some extent, via the gut) to keep their levels stable. Uric acid levels can build up either because your kidneys dont remove enough of it, or because youre taking food or medicines which cause it to rise. Its thought that the number of people with gout with a close family member also affected may be due to a genetic tendency to be a low excreter of uric acid. Medicines that can lead to a rise in uric acid levels include bendroflumethiazide a water tablet used to control high blood pressure and high dose aspirin, as well as some kinds of cancer chemotherapy. Your GP may well be able to find an alternative medication that makes your husband less prone to gout. Have a chat with the GP, but advise your husband not to stop his medicine in the meantime. Foods high in purines (chemical compounds broken down to make uric acid) include liver, kidneys, heart, herring, sardines, mussels and yeast extracts. Dehydration, a high-protein diet, alcohol and fructose-sweetened drinks can also increase uric acid levels. Cutting down on all of these, as well as losing weight, can help stave off attacks Dr Sarah Jarvis answers: Depression and pain often go hand in hand, which is not surprising given the huge impact pain can have on every aspect of your life. Depression, in turn, can cause debilitating and often profound tiredness. Other symptoms include: not enjoying things you used to; problems with sleep, concentration and appetite; feeling guilty about things that you couldnt realistically do anything about; and, in some cases, feeling youd be better off dead. Anti-depressant treatments are rarely used on their own most often theyre combined with talking therapy like CBT (cognitive behavioural therapy) that aims to help you challenge the trains of thought that can trigger or worsen depression. But while they can be effective, they dont work for everyone. They can also have side effects, including tiredness, sleep disturbance, dry mouth, constipation and blurred vision. If youve taken one for several weeks with no effect, discuss with your doctor the possibility of changing to another brand. Sometimes a new antidepressant will work even if the previous one didnt. Having osteoarthritis can also make it harder to exercise. But regular activity is one of the cornerstones to slow down progression of osteoarthritis. In clinical trials it has been shown to reduce both tiredness and depression. In fact, regular exercise is used as a treatment for tiredness from many causes, including cancer. The theory is that exercises causes our body to release serotonin, a feel-good hormone whose effect lasts long after youve stopped exercising. Your GP may be able to refer you to physiotherapy for group activities. Otherwise, low impact exercise such as swimming, cycling or gentle walking building up gradually may help in time. Arthritis Cares helpline is staffed by qualified counsellors who can give you emotional support, and its free and confidential. Call 0808 800 4050 the line is open Monday to Friday, 10am to 4pm. Arthritis Care also has a number of free booklets about arthritis that you can download from their website.