What is Gout?
The “Disease of Kings”…
…or, more commonly known as Gout, is a form of inflammatory arthritis caused by a build up of uric acid crystals (monosodium urate) in the joints. More specifically, acute gout generally affects one joint, in which 76% of patients report attacks of the big toe joint. Chronic gout refers to repeated attacks and can affect more than one joint; most commonly, the joints affected are the big toe, foot/ankle, knee and finger joints. Gout is caused by hyperuricemia which can be from diet, genetics, over-production of uric acid or an under-excretion of uric acid. The majority of patients can’t properly excrete uric acid, which is normally done by the kidneys. This creates an elevated level of uric acid in the body which creates a crystal product that is deposited in the joints causing pain, inflammation and joint destruction. Although called the “Disease of Kings” because it was thought to be associated with a diet high in proteins and fats, we know now that the underlying cause of the disorder is how one’s body handles uric acid.
Signs and Symptoms
The pain from gout usually begins suddenly and at night. The joint may look red and swollen, be warm to the touch, and be quite tender and painful. An acute attack could last a couple days with subsequent attacks lasting longer. It could be months or even years between attacks and some patients even report no further attacks.
Diagnosis and Treatments
To diagnose gout a physician can perform a number of tests such as:
Blood tests (for uric acid)
Urine tests (for uric acid)
Synovial Fluid Analysis
Joint X-rays (could look normal)
Treatment for a sudden attack usually involves the use of ice several times a day and NSAIDs or other pain relievers – either OTC or prescription. Corticosteroids may also be injected or taken orally for pain and inflammation.
For gout that occurs more frequently or is causing secondary issues such as gouty arthritis or kidney stones, your doctor may prescribe allopurinol or probenecid to decrease the uric acid levels in the blood.
Without treatment, gout could progress from acute to chronic causing destruction of the joint, joint deformities and tophi (hard painless deposits of uric acid crystals which can lead to bone erosion and arthritis). Renal issues can develop such as kidney stones or other kidney dysfunction. Without treatment there is also an increased risk of other disorders such as hypertension, diabetes mellitus, metabolic syndrome, renal disease or cardiologic disease.
Triggers and Prevention
Certain environmental conditions could trigger gout attacks. Cold weather, for one, allows the uric acid to form crystals more rapidly. This could be why feet are most commonly affected. Rapid changes in uric acid levels, from surgery, trauma, chemotherapy, diuretics, starting/stopping allopurinol, or crash diets can all be the cause of a gouty attack.
Although gout itself isn’t preventable, certain things can be avoided to help prevent attacks. Such things to be avoided are alcohol, seafood and meat (especially organ meat), obesity should be avoided.
Coffee (not tea) and Vitamin C (1500mg/day) consumption are associated with a decreased risk of gout.
Do not let gout go untreated, the long-term affects are debilitating and progressive because the uric acid crystals constantly form and build up in joints. Call today to begin treatment!