What is Gout?
Gout is a type of arthritis. It is the body’s response to poor metabolism of a certain proteins. Hyperuricemia (a condition of high Uric Acid levels) can lead to gout. The prevalence of gout in the U.S. has risen over the last twenty years and now affects 8.3 million (4%) Americans.
Who can get Gout?
- More common in Men than in Women
- More prevalent in African-American Men than White Men.
- Chance of having gout rises with age, with a peak age of 75.
- In women, gout attacks usually occur after menopause.
- If your parents have gout, you have a 20% chance of developing it.
- About 21% in USA have elevated blood uric acid levels
- Only a small portion of those with hyperuricemia will actually develop gout.
- Even those with normal uric acid levels can get gout.
What are the Risk Factors for Gout?
- Excessive weight gain, especially in youth,
- Moderate to heavy alcohol intake,
- High blood pressure,
- Abnormal kidney function are among the risk factors for developing
- Certain drugs and diseases can also cause elevated levels of uric acid
- High protein and fatty foot diet
What are the Symptoms of Gout?
Acute gout attacks are characterized by a rapid onset of pain in the affected joint followed by warmth, swelling, reddish discoloration, and marked tenderness. The big toe joint is the most common site for an attack. Other joints that can be affected include the ankles, knees, wrists, fingers, and elbows. In some people, the acute pain is so intense that even a bed sheet or a puff of air touching the toe can cause severe pain. These painful attacks usually subside in hours to days, with or without medication. In rare instances, an attack can last for weeks. Most people with gout will experience repeated bouts over the years. Chronic gout and repetitive attacks will lead to big toe joint arthritis or ankle arthritis.
What causes Gout?
Gout caused by a buildup of uric acid crystals in the joints. Uric acid is a breakdown product of purines that are a product of many foods we eat. The body will filter out most of the uric acid through the kidneys into the urine. When the body is producing too much uric acid, or the kidneys are unable to filter and get rid of enough uric acid, it can build up in the blood stream. The high concentration of uric acid will want to settle out of the blood. Joints, specifically the big toe joint, are the coldest parts of the body; owing to the fact that there is less blood flow through a joint. The uric acid in the blood will settle into the join, crystalizing. The body recognizes these uric acid crystals as foreign objects. A cascade and significant amount of inflammation rushes to the joint. This response is magnified and so intense causing significant pain and swelling.
A gout attack can be though of similar to trying to dissolve too much sugar into cold water; settling to the bottom of the glass.
How is Gout Diagnosed?
Diagnosis is achieved by the clinical examination and x-rays of the patient. Dr. Soomekh will listen to the patient’s complaints, symptoms, and goals. The examination involves a hands-on analysis of the patient’s foot and evaluating the joint. Digital radiographs (x-rays) of the feet will be obtained in the office and reviewed with the patient. A specialized CT scan of the foot may be obtained to evaluate the joint in 3D to aid in diagnosis.
Gout is considered when a patient reports a history of repeated significant pain in a joint, especially at the big toe joint or the ankle, with severe redness and swelling.
- Family History of Gout
- Detecting Uric Acid Crystals in the Joint Fluid obtained by Joint Aspiration. This common office procedure is performed with local anesthesia. Using sterile technique, fluid is withdrawn (aspirated) from the inflamed joint with a syringe and needle. Once joint fluid is obtained, it is analyzed for the presence uric acid crystals.
- Blood test to measure the amount of uric acid in the blood.
How is Gout Treated?
The treatment for gout falls into 3 categories:
- Treating the Pain and Symptoms of a Gout Attack,
- Preventing a New Attack and reducing Uric Acid Levels
- Treatment of the secondary effects of gout
Treatment for a Gout Attack:
- Anti-inflammatory medications (Indocin, Ibuprofen, Naproxen, and others)
- Colchicine (Colcrys)
- Rest and Immobilization of the Joint (walking boot)
- Steroid Injection into the Joint
Preventing a Gout Attack:
- Maintaining adequate fluid intake
- Decrease Alcohol use
- Avoid Foods High in Purines
- Avoid Shellfish and Organ Meats, such as Liver, Brains, and Kidneys.
- Weight Reduction
- Other medications decrease the level of uric acid in the blood and prevent the deposit of uric acid in joints helping to prevent further attacks and complications.
- These medications include Allopurinol, Febuxostat, and Probenicid.
Treatment of the Secondary Effects Of Gout:
Chronic gout attacks will eventually damage and deteriorate the joint cartilage in at the level of the joint or joints involved. Once the gout is under control and treated, the joints that are involved will need to be addressed.