Gout

Gout is a disease in which the defective metabolism of uric acid causes arthritis, especially in the smaller bones of the feet. Elevated uric acid in the blood stream commonly leads to sudden episodes of acute inflammatory joint pain, stiffness and swelling. The most commonly affected area is the joint at the base of the big toe but it can affect other joints and soft tissues around the foot, hands, wrists, and knees.

Uric acid is a breakdown product of certain proteins and is typically excreted through urine. When levels are high the uric acid can crystallize, forming a small solid material that deposits in and around joints. However, many people have elevated uric acid and never get gout in their entire life. Other people have a “normal” uric acid level but develop gout.

Causes

Diet is commonly blamed for gout. While diet can be an important factor, in many cases it is irrelevant. Based on research, diet is the cause of gout in less than 12% of cases. However, there is some evidence to suggest that being overweight can increase chances of developing this condition. Age, gender, genetics, medical conditions, and certain medications are all considered risk factors. In some cases trauma or surgery can precipitate gout or trigger a gout flare up. Sometimes, there is no clear cause for an attack.

Symptoms

• Gout usually presents itself in the middle of the night with swelling, tenderness, redness and sharp pain
• Attacks can last a few days or a few months

Diagnosis

The best way to diagnose gout is to aspirate (draw up with a needle) fluid from an affected joint. Unfortunately, this is a painful procedure and not always possible, especially in the small joints of the foot. With or without blood tests to indicate uric acid levels, your doctor will assess of several factors that indicate gout, including:

• Family and medical history
• Age and gender. Older males are most commonly affected by gout. It is rare in children or teenagers, barring a medical condition
• X-rays tend to be normal
• Blood tests

Treatment

Often gout flares up once and goes away forever. The treatment is rest, increased fluids, and medications and/or corticosteroids. These treatments reduce the inflammation caused by gout crystals.
A patient’s age, level of pain and risk factors will determine which medications and dosage will be prescribed. Patients usually feel relief within 24 hours if treatment is started when symptoms first appear.

If the pain from the initial attack disappears before the patient has seen a doctor, he or she should seek medical attention anyway, as a buildup of uric acid in the blood can still harm joints.

Prognosis

If gout recurs or is chronic, the patient should consult with medical doctor or foot specialist. Left untreated, chronic gout can lead to joint, tendon and other tissue damage and the formation of deposits of uric acid in the tissues, known as tophi.

Recurrent gout is treated non-surgically and most often controlled with medications that lower uric acid levels and prevent attacks. Activity modification, dietary changes and adjustment to certain medications can help reduce the buildup of uric acid in the blood. In these rare cases, surgery is necessary. Otherwise, the treatment is activity modifications, dietary changes, and medication adjustments to reduce the buildup of uric acid in the blood.

Dietary Restrictions

The link between certain foods and gout is unclear. Some studies point to alcohol, fructose sweetened drinks, meats, and seafood, while others come up with the opposite results. In some cases, too much activity in a short period of time and dehydration can lead to a gout flare up.

There is some good evidence that coffee, vitamin C, dairy products, and cherries can reduce the risk of gout. Also, regular physical exercise seems to diminish the risk.