Gout

Gout is an arthritic condition that occurs primarily on the feet, although it certainly can manifest itself in other parts of the body. It affects about 3% of the population and is predominantly a male disorder with only 5% of the cases affecting females, generally post menopause.

Gout is associated with hyperuricemia, which is an increased amount of uric acid crystals circulating through the blood, however, not all people with hyperuricemia experience gout attacks.

Unlike osteoarthritis or the "wear and tear" arthritis we all suffer, the symptoms of gout are different in that it is manifested by an acute onset of severe pain, redness and swelling, many times for no apparent reason. Many patients will complain of a sudden onset of pain occurring early in the morning while asleep. The theory behind this is that when sleeping, the feet are elevated and there is a slight diminishment of blood to the feet which in turn decreases the temperature of the feet just enough for the uric acid to crystallize in the joint of the foot and create pain.

Other factors that may precipitate a gout attack include local trauma, including foot surgery, with an acute medical illness, or following a high purine (protein) diet or alcohol binge.

Gout attacks most commonly occur in the foot, primarily in the big toe joint. The next most common locations are the middle of the foot followed by the ankle joint. They can also occur at the attachment of tendons such as the Achilles tendon into the heel. It is possible to have gout attacks in more than one area at the same time.

Diagnosis is generally on clinical appearance and the presenting history because it is not uncommon for a patient's uric acid level to be normal during an attack. Colchicine is the drug of choice in acute gout attacks and is almost diagnostic for gout if the drug alleviates the pain. There are other drugs available, primarily the anti-inflammatory class of drugs, but it is important to note that they all do not work in gout. In fact, low doses of aspirin will actually worsen a gout attack. Consultation with your foot specialist is essential.

The pain of gout generally lasts a few days, and then begins to diminish. The problem is when a person experiences multiple gout attacks over short periods of time. Aside from the pain of the attack, each attack does damage to the affected joint and a person can reach the point where there is so much damage from the repeated gout attacks, which the joint now becomes constantly painful and surgical intervention is usually necessary.

In those individuals experiencing repeated attacks of gout it is necessary to find out why. Generally speaking, it is usually from either the body overproducing too much uric acid or the kidneys excreting too little uric acid. In either event there is too much uric acid circulating throughout the body. Consultation with your family doctor is necessary to determine the cause. There is medication available to treat both causes.

Patients who are prone to gout attacks should modify their diets in regards to a low purine diet and should abstain from organ meats such as sweetbread, liver, kidney; anchovies, sardines; rich gravies and alcohol.

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