Gout
Gout is a metabolic disorder that results from the build-up of uric acid
in the tissues or a joint, most often the big toe joint. An acute attack
of gout can be very painful, marked by intense pain that comes on suddenly,
redness, swelling, and warmth over the joint. The increased warmth over
the joint is most noteable. Even light pressure, such as bedsheets, can
cause remarkable pain. Gout usually only affects one joint at a time.
Usually there is no history of trauma.
Gout attacks are caused by deposits of crystallized uric acid in the joint.
Uric acid is normally present in the blood and eliminated in the urine,
but in people who have gout, abnormally high amounts of uric acid accumulates
and crystallizes in the joints. Uric acid is the result of the breakdown
of purines, a protein that is found naturally in our bodies and in food.
Gout occurs most commonly in the big toe because uric acid is sensitive
to temperature changes. At cooler temperatures, uric acid turns into crystals.
Since the foot is furthest from the heart, it's the coolest part of
the body. However, gout can affect any joint in the body.
The tendency to accumulate uric acid is often inherited. Other factors
that put a person at risk for developing gout include: high blood pressure,
diabetes, obesity, surgery, chemotherapy, stress, and certain medications
and vitamins. For example, the body's ability to remove uric acid
can be negatively affected by taking aspirin, some diuretic medications
or water pills, and the vitamin niacin. While gout is more common in men
aged 40 to 60 years, it can occur in younger men and also occurs in post-menopausal women.
Consuming foods and beverages that contain high levels of purines can trigger
an attack of gout. You may be able to reduce your chances of getting a
gout attack by limiting or avoiding the following foods and beverages:
shellfish, organ meats (kidney, liver, etc.), red wine, beer, and red
meat. Examination, blood tests (for excessive uric acid) and x-rays are
used to determine the diagnosis. Microscopic examination of a sample of
the joint fluid, looking for uric acid crystals, provides the most accurate
diagnosis.
Initial treatment of an attack of gout may include the following:
- Medications: Prescription medications are used to treat the pain, swelling,
and inflammation.
- Dietary restrictions: Foods and beverages that are high in purines should
be avoided, since they are converted to uric acid in the body.
- Fluids: Drink plenty of water and other fluids each day, while also avoiding
alcoholic beverages, which cause dehydration.
- Elevate the foot: Avoid standing and walking to give your foot a rest.
Elevate your foot level with or slightly above the heart to help reduce
the swelling.
The symptoms of acute gout and the inflammatory process usually resolve
in three to ten days with treatment. Medications are available that will
limit the excessive production of uric acid.
Repeated gouty attacks can cause gouty arthritis within big toe joint.
This type of arthritis often causes erosions or destruction of the surfaces
of the joint. Surgery may be required to remove the uric acid crystals
and repair the joint.