Whole Foot
Gout is a disorder of metabolism of purines that make up a portion of the DNA, the material in our cells that record our genes. In the process of breaking down this substance, uric acid builds up in our blood stream. Uric acid is not very soluble in our blood stream, and even less so when the tissue is cold or the pH is low/acidic. When this happens, the uric acid crystallizes, just like a salt or sugar solution does when it dries. The uric acid crystals form in the cooler tissue of our bodies such as in the connective tissue and joints of our hands and feet, causing the inflammatory system of our bodies to activate.
When gout occurs, it looks and feels just like an infection in the joint. Spontaneous infections of the joint are rare. Swelling, redness and exquisite pain with motion are symptoms of joint inflammation due to gout. These generally last about three to seven days. At other times, the uric acid crystals can deposit in the skin and subcutaneous tissue, leaving whitish bumps that can break open causing sores.
If you are hyperurecemic or prone to gout, a simple blood test can measure this. However, uric acid levels can fluctuate and sometimes do not adequately reflect the uric acid level when the gout began. Aspirating or withdrawing fluid from the joint is the only way to accurately diagnose gout, but is sometimes unnecessary or inpractical unless a definitive diagnosis is useful.
Conditions that mimic gout include stress fractures, osteoarthritis and infection. Radiographs and other studies may be necessary to check for these problems.
Uric acid develops within the body because it is either overproduced by the body or underexcreted by the kidneys. The most common reason for gout is a defect in the excretion of uric acid by the kidney.
Gout tends to occur predominantly in men usually above the age of 30. There are definite hereditary factors that predispose people to gout. If your mother or father has had gout, there is a 20% chance that you will get it as compared to a 0.8% chance in the general population. Medications that cause gout include diuretics, water pills that are used to treat hypertension, levadopa, a Parkinson’s drug, niacin, a B vitamin, and aspirin. Chemotherapy and surgery can also initiate a gouty attack.
What do I do about Gout?
Foods, which can initiate gouty attacks, include beer, wine, and other alcoholic beverages, red meats, oily fish such as anchovies, legumes such as bean and peas, mushrooms, cauliflower, broccoli, and asparagus. Starvation and dehydration can also initiate a gouty attack.
Conditions that mimic gout include stress fractures, osteoarthritis and infection. Radiographs and other studies may be necessary to check for these problems.
Initial treatment of acute gout utilizes medications to decrease inflammation such as anti-inflammatories (indomethacin, naproxen, and ibuprofen). The area should be kept warm and covered with thick socks. Occasionally, a steroid or cortisone injection can be administered. Cholchicine is administered, one tablet every two hours to a maximum of eight per day or until diarrhea or nausea occurs. Stay hydrated and eat regularly.
Chronic treatment of gout includes treating conditions such as diabetes, chronic kidney problems and hypertension and ensuring that you are not taking any medications that could be cuasing the problem. You should also achieve and maintain a healthy weight. Medications such as Allopurinol can decrease uric acid concentrations but should not be used during a gouty attack as they can increase the severity of the symptoms
