All about Gout.

I have had two patients come into my office last week. One being treated for gout for over two years... and doesn't have it and one not knowing they have gout with supporting lab work indicating he does have gouty arthritis.
Gout is a recurring acute arthritis that affects the peripheral joints, most notably the great toe joint we call the 1st metatarsalphalangeal joint. The arthritis stems from a build up of monosodium urate crystals in and around joints and tendons. Supersaturated hyperuricemic fluids, notably joint fluids, crystallize causing a severe red, hot, swollen joint. The arthritis may become chronic and deforming. It should be of note that not all hyperuricemic people develop gout. A build up of uric acid crystals in the joint may be from excessive breakdown or over production of purines. (Purines generally come from animal products). Gout classically begins in the evenings or early mornings.
So what do you look for in a gouty attack?
1: Gout generally presents in one joint at a time.
2: Pain is sudden with the joint becoming red, hot and swollen.
3: May present with a low grade fever: e.g. < 100 degrees.
4: More common in men (20:1).
5: Generally it is joint sparing unless it is chronic, then gout can destroy the joint.
6: Most commonly attacks the great toe joint (called Podagra), followed by the middle foot and then the ankle joint.
7: Crunchy tophi felt in the ears, olecranon bursa, and the Achilles tendon.
Sometimes a diagnosis of gout can be made on x-ray which may reveal dissolving bone that looks like rat bites, punched out lesions and Martel's sign which is overhanging bone. Blood tests can also help with the diagnosis of gout but there is no consistent level unless serum uric acid acids normal values which generally range from (2.5 to 8.0 mg/dL).
Treatment ranges from Colchicine which is both diagnostic and therapeutic to a strong anti-inflammatory such as Indomethacine. Some gout patients may have to go on maintenance medications such as Allopurinal or Probenecid for a few weeks to several months.
To prevent gout, avoid foods and medications that can exacerbate a gout attack: organ meat (liver, kidney, heart and brains), lard, anchovies and sardines, alcohol especially red wines and diuretics like Lasix.

"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS