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Gout

Gout used to be known as the disease of kings. Too much red meat and red wine caused the kings of old to suffer from gout. This is actually only one cause of gout, but an important safety tip! Gout is a disorder that results from a build up of uric acid crystals in a joint. This can be your big toe joint, ankle, or knee, most commonly; but can occur in any joint or tissue in the body. (I’ve seen it in an earlobe!) Simply said, gout hurts so bad you don’t even want a sock or sheet on your foot, let alone a shoe!

What causes gout? Gout is a buildup of uric acid crystals in the joint or tissue. Uric acid is normally found in the blood and eliminated by the kidneys. Gout attacks are caused by either too much uric acid in your blood due to the kidneys having trouble eliminating it or simply you just make too much. Gout attacks the big toe joint most commonly, because uric acid turns to crystals as it cools down, and your big toe joint is the furthest from the heart, so the coolest joint in the body. (I always thought big toes were cool!) Seriously though, many people inherit the tendency to have gout and it is much more common in men than women. Other factors that precipitate gout can be high blood pressure, diabetes, obesity, surgery, chemotherapy, stress and certain medications. Food can cause gout attacks. Uric acid is the result of the breakdown of purines, so food with high levels of purines can cause gout. These included red meat, red wine, beer, shellfish, and organ meat. (I knew there was a reason I never liked liver and onions, it causes gout!).

The diagnosis of gout requires an extensive physical exam including family history, x-rays and laboratory tests for uric acid levels. It is important to distinguish gout from an infection or other inflammatory joint problem.

Treatment for gout starts with anti-inflammatory medication or injection therapy, padding and shoe gear modification. Dietary restrictions are discussed and often a long-term medication is needed to control the build up of uric acid in the blood. In a large, long-term prospective study of men aged 40 years and older, long-term caffeinated coffee consumption was associated with a lower risk for incident gout, so if you fall in this category, this may help as well. Gout can cause degenerative arthritis, so often orthotics or surgery is needed to treat the arthritic joint (See Hallux limitis/rigidus).

If you have the symptoms of gout, do not delay. The longer the uric acid is accumulating in your joint, the more destructive the crystals can be. Long-term outcomes hinge on immediate care. Call or contact the office today!