Archive for Gout
Gout
Posted by: | CommentsGouty arthritis, or hyperuricemia is a common type of arthritis that occurs when uric acid builds up in blood and causes joint inflammation. In my practice, the most common descriptors patients present with are a painful, hot, swollen and red joint in the foot. The pain often times wakes the patient at night. The first metatarsal phalangeal joint (big toe joint) is the most frequent joint involved but it may be the ankle or any other joint in the foot that becomes attacked.
Basically, we ingest chemicals in our foods called purines. These purines are broken down into uric acid and the uric acid is mostly removed from our systems though the kidneys. Gout is caused by having higher-than-normal levels of uric acid in your body. This may occur if your body makes too much uric acid (over producer) or your body has a hard time getting rid of uric acid through the kidneys (under secretor).
Like too much sugar in your iced tea, if uric acid is too concentrated in your blood it will settle out. In the case of gout it typically settles out in the form of uric acid crystals in a cool joint which makes the foot the most likely location. These crystals cause the joint to swell up and become inflamed.
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. This is often over looked.
After a first gouty attack, people will have no symptoms. Half of patients have another attack. In my practice every patient is allowed one gouty attack. Typically Dr. Sowell will give an injection, prescribe medications and they generally resolve in a few days. However, some people may develop chronic gout. Those with chronic arthritis develop joint damage and loss of motion in the joints. They will have joint pain and other symptoms most of the time. Therefore, more than one gouty attack requires extensive workup to determine the ongoing cause of elevated uric acid in the blood.
Some diet and lifestyle changes may help prevent gouty attacks:
- Avoid alcohol
- Reduce how many purine-rich foods you eat, especially anchovies, sardines, oils, herring, organ meat (liver, kidney, and sweetbreads), legumes (dried beans and peas), gravies, mushrooms, spinach, asparagus, cauliflower, consommé, and baking or brewer’s yeast.
- Limit how much meat you eat at each meal.
- Avoid fatty foods such as salad dressings, ice cream, and fried foods.
- Eat enough carbohydrates.
- If you are losing weight, lose it slowly. Quick weight loss may cause uric acid kidney stones to form.
Gout Attacks – Sowell Podiatry in Nacogdoches and Carthage Texas
Posted by: | CommentsOften times, podiatrists are the first to diagnose gout. I thought it might be helpful to get a basic knowledge of what to look for and how to handle it.
An acute gout attack is an inflammatory process that occurs in a joint secondary to a high concentration of uric acid in the blood. It is most commonly seen in the middle age, the elderly, and is much more common in men. Theoretically, it can occur in any joint in the body but is most common in the big toe joint followed by the knee and the ankle. It is extremely painful and is characterized by a red, hot, swollen joint. Patients who are undergoing acute gout attacks are usually in extreme pain and find it most difficult to even bear weight during normal walking.
What causes it?
An acute gout attack results when elevated levels of uric acid in the blood cause crystals to settle into certain joints. The body’s defense mechanism tries to fight the foreign material and an inflammatory process is initiated. Uric acid is a metabolic end product that is normally found in certain foods. People that experience “gouty attacks” have increased levels of uric acid for a variety of reasons. Often, very rich foods like alcohol, chocolate, seafood, and meats can precipitate attacks. The uric acid crystals settle in joints in one’s arms and legs because of the decreased temperature seen in the extremities. The crystals are recognized as foreign material and the body fights it like an infection. The area becomes swollen, red, hot and extremely painful. Often times, a person in an acute gout attack cannot even tolerate the bed sheets touching the affected area.
How do you treat it?
Acute gout attacks are usually treated with a combination of therapies. Oral medications such as anti-inflammatories, analgesics, and colchicine are most commonly used to treat this disorder. Often times, local injections into the affected joint will help relieve symptoms. Various other treatments include warm compresses, elevation of the involved area, physical therapy, and the use of pain relievers such as narcotics. The goal of treatment in acute gout attacks is to end the “flare up” and convert the patient’s condition to the chronic state. Certain oral medications are available on a long-term basis to help prevent recurrent attacks and possible systemic damage.
