November 12, 2013
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Gout and the Holidays!

If the joint of your big toe is hot, swollen, red and it’s unbearable to allow anything to touch it…there’s a chance you could have Gout or more specifically Podagra (Gout in the big toe).

    Gout is a type of inflammatory arthritis caused by a build-up of Uric Acid levels in the affected person’s body (caused by a metabolic disorder called Hyperuricemia.) While the production of Uric Acid is a normal process of human metabolism, increased levels in your blood could cause an “attack” of Gout.

    These attacks occur when the Uric Acid forms crystals that become deposited in joint spaces. These spines of Uric Acid cause the pain, swelling and hyper-sensitivity so common in the affected area (imagine having a bunch of little needles inside your toe!). These crystals have also been found to form tophi on the skin and stones in the kidneys.

*Most Gout attacks occur at night because the body temperature lowers and prompts the Uric Acid to precipitate into jagged little crystals.*

Picture of Urate crystals in joint fluid from http://www.arthritisresearchuk.org/

While a simple blood test will reveal an elevated Uric Acid level, Gout is technically diagnosed by a procedure called joint aspiration. In this procedure, your doctor will use a needle to draw fluid out of the affected joint cavity, which will then be analyzed for urate crystals as well as bacteria to rule out infection of the joint as the cause for pain (Septic Arthritis). X Rays are also utilized to determine the extent of Gout, and monitor both bone and joint damage.

A newly diagnosed patient suffering from Gout should be assessed for underlying causes that may be aggravating the Hyperuricemia. Factors that have been found to be associated with Gout include obesity, diabetes, hypertension, diuretic use, alcohol intake and a diet of foods rich in Purines. Gout tends to have a family history.  Patients are encouraged to ask their parents and grandparents for information about other family members having a history of Gout.

Foods Notorious for High Levels of Purines

  • Asparagus
  • Beer and other Alcoholic Beverages
  • Organ meats (liver, kidneys, sweetbreads)
  • Dried beans and peas
  • Fried foods and trans fats
  • Gravies, consomme, meat extracts, cream sauces
  • Salmon, Trout, Haddock, Sardines, Mackerel or Herring ,fish roes and Anchovies
  • Shellfish, clams, lobsters, mussels, scallops and shrimp
  • Veal , Bacon, Lamb, Liver, Turkey and Pheasant
  • Yeast and Yeast derived products
  • Extreme Foods to Avoid: Artificial sweeteners, carbonated drinks, cigarettes, Flour (white wheat), Goat, Lamb, Pastries and cake from white flour, Pork, Sugar, Beer, Brown Sugar, Deer, Chocolate, Coffee, Custard with white sugar, Jams, Jellies, Liquor, Pasta, Rabbit, Semolina, Table salt refined and iodized, Tea (Black), White Rice, Vinegar
  • www.blpublications.com 

Management of Gout should be targeted at reducing the circulating levels of Uric Acid in the body long-term while also treating flare-ups and reducing the arthritic damage that can be caused by severe chronic Gout.

 

Picture from www.orthopaedics.com

Gouty attacks can be prevented, or at least made to happen less frequently, in a number of other ways besides watching dietary intake of Purine-rich foods. Weight-loss, drinking plenty of fluids, changing certain medications, adding medications like Allopurinol and Uloric can help reduce Uric Acid levels.

Usually NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) like Ibuprofen or Naproxen will be prescribed to alleviate the pain associated with the flare-ups. Corticosteroids may also be prescribed but an individual treatment plan is always best for the management of any ailment.

Treatments vary depending upon the the severity of each Gout attack. One must take into account how long it has been since the symptoms first started as well as how many previous Gout attacks have occurred. The overall medical history of each patient and what medications they've already been prescribed must be considered. 

First time treatments may involve a cortisone injection into the affected joint and a prescription to reduce the Uric Acid and relieve the pain. If Gout attacks persists and the Uric Acid levels remain elevated, then long term prescription management is recommended. 

***Helpful Supplements for Gout Treatment are Cherries & Cherry juice, Celery, Pineapple & Tumeric***

Remember that Gout not only affects the great toe, but often occurs in other joints in both the foot and the rest of the body. First time attacks usually occur in the great toe, and secondary attacks may go to other joints in the foot and ankle or other areas of the body. 

If Gout is left untreated, consequences may be chronic Gout pain or destruction of the joint where the Gout occurred resulting in permanent arthritis pain. Also, Gouty tophi may appear as whitish nodules around the joints. These are often painful/visible and result in permanent changes to the bone and joint.

(This x-ray show Gouty Tophi in the big toe joint. Picture from WebMD.com) 

If you feel like you may have a case of Gout or another painful foot related ailment please contact Foot & Ankle Associates, (Dr. Garibaldi and Dr. Harper) for effective, personal and professional treatment.