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Gout commonly occurs at night and certainly can seem to be a nightmare. Often affecting the great toe, (referred as podagra) painful swelling, redness, heat and severe pain develop. The pain can be so severe that the weight of the bed sheet can cause terrible discomfort.
Gout is an inflammatory form of arthritis that occurs when a bodily waste product, uric acid, is deposited in the joints. These needle like crystals of uric acid cause the inflammation that leads to an attack of gout. Usually gout affects one or two joints but on occasion multiple joints can be affected. Men are most often affected and it is uncommon to occur in women prior to menopause.
Uric acid is produced from the breakdown of purines, a normal constituent of bodily tissues as well as being present in many foods. Usually the uric acid is excreted from the kidneys into the urine. However, if the kidneys are damaged and do not eliminate enough uric acid, or if certain medications interfere with the kidneys ability to excrete uric acid, then blood levels can build up. Some medications that can interfere with uric acid elimination include certain diuretics. An increased production of uric acid can also occur, usually from breakdown of bodily tissue or from ingestion of certain foods. Both the under excretion and overproduction of uric acid can lead to increased blood levels referred to as hyperuricemia. At this point uric acid crystals can be deposited in the joints and other tissues and lead to an attack of gout. An acute attack can be triggered by stressful events, medications and alcohol. Although attacks usually resolve on their own they can be quite debilitating. If attacks continue to recur, a disabling disorder referred to as chronic tophacous gout can develop leading to permanent damage to joints as well as the kidneys.
The diagnosis of gout is not always straightforward. An elevated blood level of uric acid is not enough to confirm a diagnosis of gout, as not all people with an elevated uric acid will develop symptoms. Other conditions can mimic gout, such as infection. For a definitive diagnosis, fluid can be withdrawn from an inflamed joint and examined for the presence of uric acid crystals. If these crystals are present in the synovial fluid then diagnosis of gout is established.
The good news is that most cases of gout can be controlled thus preventing damaged to the body. Acute treatments may include medications such as anti-inflammatory drugs or corticosteroids to get control of the acute inflammation as well as chronic medications to lower the amount of uric acid in the blood. These latter medications are only used once the acute attack has resolved and include allopurinal which interferes with the production of uric acid and probenecid which helps the body excrete more uric acid in the urine.
There are steps that you can do to minimize the consequences of gout including: - Review all your medications with your physician to see if you are at risk for hyperuricemia.
- Maintain a healthy body weight.
- Exercise regularly
- Drink plenty of nonalcoholic fluids. Alcohol can increase the levels of uric acid and precipitate a gout attack.
- Avoid high urine foods (asparagus, gravy, dried beans, peas, game meats, mackerel, sardines, beer, aged cheese, organ meats).
- Dr. Keith Reich Rheumatologist/ Arthritis Specialist
For more information on foot and ankle health, or to make an appointment with a podiatrist, please call Foot & Ankle Specialists of West Michigan at any of our many locations. |
