Gout

What is gout?

Gout has the distinctive merit of being one of the most frequently recorded medical illnesses throughout history. Gout, unlike an injury, does not involve muscle tissues being injured.

It is often related to an inherited irregularity in the body’s ability to process uric acid. The term gout refers the disease caused by an overload of uric acid in the body, resulting in painful arthritic attacks and deposits of lumps of uric acid crystals in body tissue, such as the joint of your big toe.

  • Acute gout is a painful condition that typically affects a single joint.
  • Chronic gout is repeated episodes of pain and inflammation, chronic gout may involve multiple joints.
  • An abnormality in handling uric acid can cause attacks of painful gout attacks, kidney stones, and blockage of the kidney-filtering tubules with uric acid crystals, leading to kidney failure.
  • Some people may only develop elevated blood uric acid levels (hyperuricemia) without having signs of gout.
  • An elevated level of uric acid in the blood without symptoms is referred to as asymptomatic hyperuricemia. Asymptomatic hyperuricemia is considered a precursor state to the development of gout.

Common sites for gout attacks
(photos from Foot Pain Explained)

Gouty arthritis is typically an extremely painful attack with a rapid onset of joint inflammation. The joint inflammation is precipitated by deposits of uric acid crystals in the joint fluid and joint.

Intense joint inflammation occurs as the immune system reacts, causing white blood cells to engulf the uric acid crystals and chemical messengers of inflammation to be released, resulting in pain, heat, and redness of the joint tissues. As gout progresses, the attacks of gouty arthritis typically occur more frequently and often in additional joints.

What is Uric Acid?

Uric acid is a breakdown product of purines that are part of many foods we eat. When cells die and are recycled by our bodies, the purines in their genetic material also get broken down. Uric acid is the chemical formed when purines have been broken down completely.

What causes gout?
  • The exact cause is unknown.
  • Gout may run in families.
  • It is more common in men, in women after menopause, and those who drink alcohol.
  • People who take certain medicines, such as hydrochlorothiazide and other water pills, may have higher levels of uric acid in the blood.
Are there other disease states that may make me more likely to developing gout?
  • Diabetes
  • Kidney disease
  • Obesity
  • Sickle cell anemia and other anemias
  • Leukemia and other blood cancers
  • Certain medicines that interfere with the removal of uric acid from the body (e.g. thiazide diuretics (hydrochlorothiazide [Dyazide]), low-dose aspirin, niacin, cyclosporine, tuberculosis medications (pyrazinamide and ethambutol) and others)/li>
What are the Symptoms of Gout?

Uric acid crystals can deposit in tiny fluid-filled sacs (bursae) around the joints. The crystals can provoke inflammation in the bursae, leading to pain and swelling around the joints (a condition called bursitis).

How do I know if I should suspect that I have gout?

Nodular or small knobby masses of uric acid crystals deposit may be found in different soft-tissue areas of the body, most frequently around the fingers, at the tips of the elbows, in the ears or around the big toe. When a patient has a history of attacks of painful arthritis, particularly at the base of the toes, clinicians will suspect gout. Ankles and knees are the next most commonly involved joints in gout. Usually gout attacks one joint at a time.

What medical test or exams are done to diagnose gout?
  • Synovial fluid analysis to look for uric acid crystals. Synovial fluid is normally a thick, straw-colored liquid found in small amounts in joints, bursae (fluid-filled sacs in the joints), and tendon sheaths.
  • Synovial biopsy (removal of a piece of tissue lining the impacted joint)
  • Lab test to measure the amount of Uric acid in your blood or urine
  • Joint x-rays (may be normal despite having an outbreak of gout)
How can gout be treated?

  • Use an Arctic Ease Cryotherapy® Wrap or pad to minimize inflammation and reduce pain
  • Avoid alcohol and limit your intake of foods with high Purine levels. These include:
    • Foods with very high purine levels (up to 1,000 mg per 3.5 ounce serving): Anchovies, Brains, Gravies, Kidneys, Liver, Sardines, Sweetbreads
    • Foods with high and moderately high purine levels (5-100 mg per 3.5 ounce serving): Asparagus, Bacon, Beef, Bluefish, Bouillon, Calf tongue, Carp, Cauliflower, Chicken, Chicken soup, Codfish, Crab, Duck, Goose, Halibut, Ham, Kidney beans, Lamb, Lentils, Lima beans, Lobster, Mushrooms, Mutton, Navy beans, Oatmeal, Oysters, Peas, Perch, Pork, Rabbit, Salmon, Sheep, Shellfish, Snapper, Spinach, Tripe, Trout, Tuna, Turkey, Veal, Venison
  • Your health care provider may give you ibuprofen or another nonsteroidal anti-inflammatory drug (NSAID) to help with the pain and swelling.
  • Corticosteroids or other intra-articular corticosteroids can be used, particularly in patients who have contraindications to NSAIDs.
  • If you are overweight, losing weight can be helpful in lowering the risk of a repeated attack of gout.