What is Gout?

Gout is a form of inflammatory arthritis caused by excess uric acid in the bloodstream, called hyperuricemia. Everyone has uric acid in their body, but in some people the concentration rises excessively causing tiny microscopic crystals of monosodium urate to be deposited in joints and elsewhere. These crystals create an acute inflammation which can be very painful. It most commonly affects the joint at the base of the big toe, called the first metatarsophalangeal joint, but it can happen in any joint in the body. If gout becomes chronic with repeated attacks it can even cause deposits of crystals to form in joints, soft tissues, and around tendons. These lumps of gouty material are called tophi and are often seen on the feet, toes, fingers and back of the elbows. It can also cause permanent damage to joints with repeated attacks. Gout is most common in middle aged to older men and usually only affects women after menopause. It is believed that gout affects about 9 million Americans.

What Causes Gout?

There are many factors that can contribute to gout which include:

  • People with certain medical conditions such as high blood pressure, high cholesterol, kidney disease, obesity, and diabetes are more susceptible.
  • There seems to be a hereditary component to gout. If other family members have a history of gout you are more likely to get it.
  • Eating certain foods which are high in purines that get converted to uric acid can trigger gout. These can include red meats, organ meats like liver, and shellfish such as shrimp, lobster, and crab.
  • Food and drinks that are high in fructose.
  • Alcohol use, especially beer and wine.
  • Joint injury or trauma can trigger an attack.
  • Surgery may trigger gout.
  • Certain medicines like hydrochlorothiazide (HCTZ), aspirin, cyclosporin, and chemotherapy.

Symptoms of Gout

  • Sudden onset of severe pain in a joint accompanied by swelling, increased temperature of the overlying skin, and usually some degree of redness.
  • By far the most common joint affected is at the base of the great toe, but it can occur in other joints as well and occasionally in soft tissues like the Achilles tendon.
  • Attacks often begin at night while sleeping. The pressure from sheets on the foot may be intolerable. Wearing shoes can also become difficult due to the swelling present.
  • If gout has been longstanding, then visible lumps of gout deposits (tophi) may be present on toes, fingers, feet, around the Achilles tendons, the elbows, and other locations. These are usually not painful.

Diagnosis

  • A blood test may be ordered to check the uric acid level. Anything greater than 6.0 mg/dL can allow for urate crystal formation. This test is not 100% accurate however, as it is possible to have gout with normal uric acid levels.
  • X-rays might be done to assess for joint damage or other problems
  • A needle may be used to withdraw fluid from the joint for microscopic analysis to see if there are gout crystals present. This is called arthrocentesis.

Treatment of Gout

  • Anti-inflammatories (NSAID’s) such as OTC ibuprofen, Naprosyn, or stronger prescription Indocin can be helpful.
  • Ice the area regularly for no more than 20 minutes at a time.
  • Stay hydrated by drinking lots of water. Avoid alcohol and sugary drinks.
  • Colchicine may be prescribed but can cause GI side effects.
  • An oral dose of steroids may be prescribed for several days.
  • On occasion your podiatrist may inject steroid medicine directly into the affected joint.
  • For those with chronic, repeated gout attacks, a medication called allopurinol can help reduce uric acid levels and gout over the longer term.
  • If tophi deposits are numerous, large, or causing pain then an infusion called Krystexxa may help to dissolve them.
  • Avoid eating foods that trigger attacks.
  • For those who prefer a more holistic approach, cherries have been found to have a significant anti-inflammatory and antioxidant effect along with lowering uric acid levels. Consuming cherries, cherry juice, or cherry extract vitamins may reduce the severity and frequency of gout attacks.

If you think you may be suffering from gout please give Dr. Davis and staff a call to set up an evaluation. There are other conditions which can mimic gout such as infection, broken bones, Charcot, and psoriatic arthritis.

Gout Specialist
Judd Davis, DPM with A New Step Foot & Ankle Clinics is a compassionate podiatrist (foot and ankle doctor) who helps patients with gout, foot pain and other foot problems. Gout can be very painful but A New Step Foot & Ankle Clinics can help. Lifestyle factors, especially diet, may be contributing to gout pain and flare ups. A New Step Foot & Ankle Clinics is located in Colorado Springs, Colorado.