Gout

What is Gout?

Gout is an extremely painful form of arthritis that most commonly affects the big toe (called podagra) but, can also attack the feet, ankles, knees, and hands. The condition is very painful and can be quite disabling. Men are far more likely to be affected than women and it usually occurs after age 30. Some people get a gout attack and never get one again, while others get them regularly. These attacks, or “flares”, usually last 2-4 weeks.

How did I get Gout?

Gout occurs as a result of a buildup of uric acid in the blood.  Uric acid is a break down product of purines, which is an amino acid found in certain foods. If the concentration of uric acid in the body becomes too great, it will crystallize out in the joints. These crystals tend to accumulate in certain joints, especially in the feet. Uric acid crystals are needle shaped and responsible for the severe pain and damage to the joint that occurs with gout.

What are the symptoms of Gout?

The classic presentation of gout is to wake up one morning with a painful, hot, red, swollen foot. The joint by the big toe is the most commonly affected site but, the ankle and mid-foot are not uncommon sites. The condition is usually self limiting and resolves by itself in weeks to months. In spite of the fact that gout is self limiting, it is important to treat the condition because it causes irreversible damage to the joints. Gout slowly erodes the joint and multiple episodes usually result in permanent arthritis.

Are there tests for Gout?

Gout can usually be diagnosed by a clinical presentation of a red, hot, swollen, painful joint. There is a blood test for gout whereby the uric acid content of the blood is measured, but this test can be unreliable.  The most conclusive way to diagnose gout is to draw fluid off the joint and look for the gout crystals. There are also classic findings on x-ray that can help with a diagnosis.

What can I do if I get Gout?

Gout it is usually treated with NSAIDS, pain medication, and immobilization of the foot. Immobilization is important because the more the joint moves, the more the crystals cause damage. NSAIDS help with the inflammation caused by the damaging crystals. There is some controversy regarding applying ice to the area. While ice helps calm down the inflammation, it may also slow down the body’s ability to dissolve the crystals. For severe gout attacks, your podiatrist may inject cortisone into the joint to help with inflammation.

Are there medications for Gout?

Yes! For people who suffer with chronic gout attacks, there are special medications for the condition including: Allopurinol, Probenecid, and Colchicine. Your medication will depend on whether your body makes too much uric acid or has a hard time getting rid of uric acid.

What can I do to avoid getting gout?

Avoiding certain foods will help decrease the bodies concentration of uric acid; however, since  purines are found in so many foods, sticking to a strict diet can be difficult. Limiting the amount of these foods can be beneficial.

  • Avoid red meat particularly organ meats including liver, sweetbread, kidney, brain, tongue, and tripe.
  • Avoid certain seafood particularly sardines, herring, anchovies, roe, and mackerel.
  • Avoid certain shellfish including scallops, oysters, lobster, crab, and shrimp.
  • Avoid alcohol, especially beer.
  • Avoid becoming dehydrated as this concentrates the uric acid in the blood causing it to crystallize. (Patients on diuretics are more likely to develop gout for this reason)

Certain vegetables including asparagus, cauliflower, lentils, beans, peas, and spinach have long been thought to cause gout due to their high purine concentration; however, recent studies have shown that your body breaks down vegetable purines differently, making them safe to eat.

Patients with chronic gout often develop lumps or masses under the skin from a buildup of gouty tophi. Gouty tophi develop from years and years of chronic gout. Gouty tophi presents as white or yellowish-white, chalky masses that can be visualized through the translucent layers of the skin. In the feet, gouty tophi masses are most common in the joints of the toes. Sometimes, the tophi break through the skin forming an ulceration that drains chalky white material. For those who develop gouty tophi that are painful or burst open and drain may require surgery to remove the tophi and prevent chronic ulcerations. When it occurs in the small joints in the feet, the joint is often fused.

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