Gout has been a problem for patients for thousands of years. It was referred to as “The King’s Disease” due to the prevalence in the monarchy and upper class. In this blog, we will go over what gout is, how to avoid it and how to treat it.
Gout occurs when a collection of uric acid crystalizes out of the blood stream and deposits near a joint. This causes the joint to become red, hot, swollen and painful. It occurs most often in the big toe and ankle, but can be seen in any joint. Uric acid is a waste product of metabolism involved in the breakdown of purines. Certain foods are known to be high in purines and can trigger a gout attack including yeasty breads, alcohol, high fatty meats and shell fish. A gout attack can be caused from over indulging on one of these foods, injury, cold weather, shoe gear or can have no obvious trigger.
The process of gout formation can be broken up into two groups; overproducers of uric acid or under-excreters. Patients who overproduce uric acid may lack an enzyme needed to properly metabolize uric acid. Under-excreters may have impaired kidney function or may be taking medications that are impeding the process such as high blood pressure medicine.
A gout attack occurs when the level of uric acid becomes too high in the blood stream. A “breaking point” will occur and trigger crystal formation near the joint. Gout attacks are extremely painful with many patients reporting pain so severe that they cannot even stand the bed sheet touching the toe. The joint will often be red, hot and swollen.
Gout can be diagnosed by physical exam, xrays and aspiration of the joint. Blood tests can also be performed to check the uric acid levels, however these may be falsely lowered during an active gout attack.
If you are experiencing an attack there are many treatments available. Your podiatrist may suggest a joint injection with steroid, non-steroidal anti-inflammatories, oral steroids, immobilization in a boot or colchicine for an acute attack. Xrays, blood tests or joint aspiration may be needed for diagnosis. It is important to rule out infection as a cause. DO NOT stop taking blood pressure medication unless told to do so from the prescribing doctor.
Long term treatment options include diet control and avoiding trigger foods. Your physician may start you on a uric acid lowering drug such as Uloric or Allopurinol. Changing blood pressure medications can help in some cases and should be discussed with the prescribing physician. If frequent gout attacks have caused a buildup of gout crystals (tophi), surgery may be required to remove them.
If you suspect you are having a gout attack, seek treatment ASAP to help with pain and lessen joint damage. Gout should be diagnosed by an experienced physician as there are other problems that can cause similar symptoms.
Chris Suykerbuyk, DPM, FACFAS