What is it?
Gout is a condition characterized by elevated levels of uric acid in the blood. The excess uric acid forms crystals that settle in various joints, most commonly the big toe joint. Gout is a chronic disease that typically begins with recurring attacks. During an attack, the affected joint becomes swollen, red, and extremely painful, with symptoms that can last several days. Patients often find it intolerable to have even a sheet resting on their big toe or other parts of their foot, such as their heels or ankles. The foot is particularly susceptible due to continuous pressure from walking, increased trauma, and a tendency for blood to pool in the extremities.
What causes it?
Gout is a metabolic disorder that is relatively common, particularly among middle-aged and older men, who are seven to eight times more likely to suffer from it than women. Genetics also play a role, so a family history of gout increases the risk of developing the condition. Alcohol consumption can exacerbate gout and trigger frequent attacks, as can the use of diuretics (water pills), which contribute to elevated uric acid levels in the blood.
How do you treat it?
Treatment for gout typically starts with reducing pain and swelling. This involves keeping weight off the affected joint, elevating it, and resting it. Anti-inflammatory medications are used to alleviate pain and swelling and to help eliminate uric acid from the body. Steroid injections into the joint can also reduce pain and inflammation. To prevent future flare-ups, it’s advisable to avoid alcohol and foods high in protein, and to drink plenty of water to help dilute uric acid levels. For patients with recurrent gout attacks, preventive oral medications may be prescribed. Surgery is generally considered only if other treatments have failed, and it involves remodeling the affected joint or joints.
Acute Gout Attack
What is it?
An acute gout attack is an inflammatory response in a joint caused by high levels of uric acid in the blood. It is most common in middle-aged and elderly men and typically affects the big toe joint, although it can also occur in the knee and ankle. The joint becomes extremely painful, red, hot, and swollen. During an acute attack, patients often experience severe pain and difficulty bearing weight, with even the touch of bed sheets causing intense discomfort.
What causes it?
An acute gout attack occurs when elevated uric acid levels lead to the formation of crystals in the joints. The body’s immune system reacts to these crystals as if they were foreign invaders, initiating an inflammatory response. Elevated uric acid levels can result from consuming rich foods such as alcohol, chocolate, seafood, and meats, or from medications that increase uric acid levels. The cooler temperatures in the extremities make the joints more prone to crystal deposition. This inflammatory response causes the affected area to become swollen, red, hot, and intensely painful, making it one of the most painful conditions we treat.
How do you treat it?
Treatment for acute gout attacks involves a combination of therapies. Commonly used medications include anti-inflammatories, analgesics, and colchicine. Local injections into the affected joint can also provide relief. Additional treatments may include warm compresses, elevation of the affected area, physical therapy, and pain relievers like narcotics. The goal is to manage the flare-up and transition the patient to a chronic management plan. Adopting a low-purine diet can help prevent future attacks.
Long-term oral medications are available to help prevent recurrent attacks and potential systemic damage. Patients should consult their family physician or internist for more information on these medications.
