Gout

Gout is a medical condition that commonly affects the big toe joint and other joints of the foot. Gout is a type of arthritis causing sudden and intense pain, joint swelling and stiffness commonly in and around the big toe joint. These attacks will continue until gout is treated. If gout is not treated immediately these attacks can harm the joints and tendons around the joint and damage other tissues. It tends to be more common in men, but this doesn’t mean that women do not get gout.

Gout is brought on when there is too much uric acid in the blood.  This must not be confused with “urine”! Uric acid comes from the natural breakdown of our body cells and the foods we eat. Normally, the majority of uric acid is removed by the the kidneys and leaves our body when we urinate. However, if there’s too much uric acid being made by the body, or too little being eliminated, the bloodsteam and joints can become saturated with uric acid.  Once this happens any more uric acid will be deposited as crystals in and around any joint with the big toe joint being very commonly affected.  These crystals cause an intense, immediate, inflammation with severe pain, swelling and redness of the area affected.

A typical gout attack is a person being awakened in the middle of the night from their sleep with incredible pain in their big toe joint. Even the touch of the sheets causes intense pain. The chance of having high levels of uric acid in one’s blood come from being overweight, drinking too much alcohol, or eating too much meat or fish that have high levels of purines. Some medicines, such as diuretics, can also cause gout.

To determine whether or not someone has gout, the doctor will ask questions regarding your symptoms, do a physical exam and take x-rays. Examining joint fluid under a microscope for crystals is the best way to determine whether someone has gout however, sticking a needle into someone’s joint that is already intensely painful is not an attractive option.  A blood test to check uric acid levels is good medicine.  Results must be correlated with clinical findings for proper interpretation of blood test results.

Gout and high blood pressure seem to run together in many cases. Gout can be the first indication of a cancerous tumor somewhere in the body.  Because cancer cells multiply rapidly, there is a lot of cell breakdown which in turn produces uric acid in excess of normal production.  Therefore a gout attack should include a full examine in order to make sure it is just gout by itself and not a symptom of another problem not being seen or experienced.

There are four distinct phases of gout and depending on which one you are in will determine the kind of treatment. There’s hyperuricemia, which is just too much uric acid in the blood. There are no symptoms but that doesn’t mean damage isn’t happening. When hyperuricemia is associated with symptoms you have symptomatic hyperuricemia.

Then there’s acute gout, which is when the uric acid crystals have formed in a joint causing the intense pain etc. described above. The symptoms will last from 3 to ten days and during that time additional gout attacks can occur.

Interval gout is the period of time between the acute gout attacks. There won’t be any symptoms during this time.

Chronic tophaceous gout will occur if gout goes untreated. It can take up to 10 years or longer for gout to get to this stage. At this point, hard nodules develop around your joints and in the skin. This is when damage has occurred and could be irreversible if the damage has progressed far enough.

The sooner gout is found and treated the less chance for long lasting effects.

If you have any of these symptoms, you could have gout:

• Increased pain
• Swelling
• Redness around the joints
• Nodules
• Attacks of pain, especially in the middle of the night

If you have, or think you may have gout, please don’t hesitate, call Family Foot Center at 718-767-5555.

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