Patient Education

Gout

Description

Ah, gout. The disease of the elderly retired British military man, with his white walrus moustache, shiny monocle, red face and irascible nature, not to mention his crystal decanter of brandy nearby. You can just picture him,

Actually, gout really doesn’t have anything to do with being British, although it is more likely to occur in men than women, and in older men rather than young ones. In fact, women usually don’t develop gout unless they’re post-menopausal or have had a hysterectomy.

So, what is gout, anyway? Because it affects the joints, it’s actually a type of arthritis, one that’s precipitated by an unusually high amount of uric acid hanging out in the blood. Uric acid itself is a natural byproduct of breaking down cells in our food (like meats) and building up body tissues. It gets dissolved into the bloodstream and usually gets excreted in urine, where it passes on to the sewers. (Sewers don’t really use uric acid in any way.) Unfortunately, some people naturally produce more uric acid than usual, and others have trouble getting rid of uric acid in the blood. This results in a condition known as hyperuricemia, which is a higher than usual concentration of uric acid in the bloodstream. Eating foods that are high in purines (like organ meats and other foods) tend to result in higher levels of uric acid in the blood, and may result in a gouty attack.

When uric acid in the bloodstream reaches a certain level, it may start to crystallize in a joint (or sometimes other tissues). These needle-shaped crystals cause extreme pain and make the joint swell up. Gout most often develops in the big toe joint (where the big toe connects to the foot), although it also may occur in the knee or ankle, or other joints or tissues. Uric acid seems to crystallize in parts of the body that are cooler, or that have experienced trauma. Because the big toe joint is located so far from the rest of the body (and thus is cooler), and because it’s frequently under such stress, it seems to be most susceptible to the formation of uric acid crystals.

You may be more prone to developing hyperuricemia and gout (although gout does not always happen if you have high levels of uric acid in the blood) if you have or do any of the following:

  • Obesity
  • Diabetes
  • High blood pressure
  • Consume alcohol
  • Eat large amounts of foods containing purines
  • Kidney disease
  • Sickle cell anemia
  • Leukemia
  • Take certain medications (some diuretics, aspirin, the vitamin niacin)

Symptoms

As noted above, an attack of gout is usually extremely painful, and it often comes on quite suddenly. You may go to bed at night, feeling the world is a happy place, then wake up in the morning in excruciating pain. Gout is sneaky like that.

The affected area (again, often the big toe joint) will become inflamed, which means swelling, redness, pain, and heat. The skin over the joint may begin to look tight and shiny. Even light touches can cause extreme pain, so you may not even be able to stand the weight of a sheet or blanket over your gouty toe. You may also experience fever or chills, or aches throughout your body. In fact, gouty attacks are sometimes mistaken for infections.

Attacks will peak within a few hours, but you’ll probably continue to experience symptoms for several days, especially if the attack is not treated. Over 50% of people who experience one attack of gout will experience another. Gradually, the time between attacks diminishes, and the joint will eventually become permanently damaged.

Diagnosis

Your podiatrist will be able to diagnose your gout whether you’re British or not. He or she will probably ask you about your family and medical history (a predisposition for gout can run in families), and will most likely make a physical exam of your foot. There are some tests that can determine the amount of uric acid in your bloodstream, although during an actual attack of gout, the uric acid in your blood may be low, since it’s gone and gotten all crystallized in your joints. However, your podiatrist may draw fluid from your joint itself to see if there’s any sign of uric acid crystals (or infection, which can also cause similar symptoms). Your urine may be tested for uric acid levels, and your podiatrist may order X- rays of your joint to rule out other possible causes of your symptoms.

Treatment

Unfortunately, gout cannot be completely cured. But the good news is that gout can be kept well under control, if you’re willing to put in a bit of effort. (But then, a little effort to avoid a LOT of pain sounds like a pretty good deal, doesn’t it?)

During the gout attack itself, your main goal will be to reduce the inflammation in your joint. This may be accomplished by taking anti- inflammatory medication (often prescription strength) such as ibuprofen or corticosteroid injections. Elevating the affected joint (at or slightly above heart level) will also provide relief. Avoid walking or otherwise putting stress on the joint.

Once you’ve begun treatment, you should experience some relief within twelve to twenty-four hours, and your symptoms should be resolved within three to ten days. After the inflammation has disappeared, you’ll be able to avoid future attacks by making dietary changes, and by taking medication that will enable your body to either block the formation of uric acid, or increase your ability to eliminate uric acid already in your bloodstream. Gradual weight loss may also help prevent future attacks (although be aware that rapid weight loss can actually precipitate attacks).

Dietary restrictions usually involve avoiding food that contain high amounts of purines. (Remember, purines can lead to high uric acid levels in the blood.) You may be asked to reduce your intake of or completely avoid the following foods:

  • Organ meats (such as liver, sweetbreads, brain, kidneys, heart, etc.)
  • Gravies, meat extracts and meat broths
  • Fish (particularly herring, mackerel, anchovies and sardines) and scallops
  • Goose and wild game
  • Legumes (dried beans and peas)
  • Mushrooms, spinach, asparagus, cauliflower
  • Fatty foods (such as fried foods or high-fat desserts)
  • Baker’s or brewer’s yeast
  • Alcoholic beverages (beer, wine, hard liquors)

This can seem like a lot to give up. Perhaps it’s best if you think of gout the way one might think of diabetes. Making the necessary lifestyle changes may be difficult, but the alternative is experiencing pain and eventual damage to your body. Like diabetes, gout can be controlled by following the instructions of your friendly podiatrist. And really, there’s no reason why you should spend your life cooped up with your monocle and old war stories. With proper maintenance, there’s no reason why you can’t live completely free from gout attacks. (And, okay, you can probably keep the monocle anyway. But only if you want to.)