GOUT /
SWOLLEN - PAINFUL JOINT
By: Corinne Gehegan, DPM
 Gout is a painful, inflammatory condition that occurs about joints with
the highest incidence in the foot. The condition results from high
levels of uric acid in the body. Uric acid is a by-product produced by
the natural break down of purines. Purines are found within the cells of
the body as well as in many foods. Uric acid is carried through the
blood to the kidneys where it is eliminated in the urine. Gout can occur
if the body produces excess uric acid or the kidneys do not eliminate it
adequately or efficiently. In these cases the uric acid forms needle
like crystals which precipitate from the blood and collect within soft
tissue structures or within joint fluid. This collection of crystals is
very painful and is associated with redness, swelling, and warmth about
the affected area. The pain may be so severe that even the slightest
touch can intensify the pain.
Men are more likely to experience gout attacks, but women may be just as
susceptible after the onset of menopause. Other risk factors include
family history, consumption of alcohol, hypertension (high blood
pressure), diabetes, increased cholesterol levels, and arteriosclerosis
(narrowing of the arteries). Certain medications may increase the risk
of gout. Examples of these medications are thiazide diuretics (water
pills), low dose aspirin, and anti-rejection medications for post organ
implant patients. Do not discontinue these medications or change their
dose/frequency without first discussing this with your doctor.
Gout is most often diagnosed after taking a thorough history in addition
to examining the area in question. X-rays may be performed to rule out
other conditions that can mimic gout. Some of the conditions that may
have similar presentations are infection, acute diabetic Charcot
neuroarthropathy, trauma, insect bites, and other types of arthritis.
Arthritis due to repeated gout attacks may not be evident on x-ray until
several years have passed since the first attack. A blood test may be
performed to determine the level of uric acid in the blood; however, the
level may be normal even in the midst of a gout attack. On the contrary,
some individuals have high levels of uric acid in the blood, but have
never experienced a gout attack. Therefore, the test is not reliable.
Tophi are deposits of uric acid crystals under the skin. They appear to
be nodules and are usually not painful. Typical locations are the ears,
elbows and hands.
A gout attack is typically treated with oral medication, particularly
anti-inflammatory medication. Within a day or two symptoms should
diminish. NSAIDS (non-steroidal anti-inflammatory drugs) are often
recommended in either over the counter varieties such as ibuprofen or
prescription strength such as indomethicin. Steroids may be indicated
and are available in an oral form or by injection. Colchicine
effectively blocks the inflammation caused by uric acid crystals and can
be used to treat an attack and prevent future attacks. If gout attacks
occur several times a year other medications may be prescribed to manage
the condition. Allopurinol is an example of a medication that works to
lower the production of uric acid. Probenecid is an example of a
medication that promotes elimination of uric acid. All of the above
classes of medications have side effects as well as the ability to
complicate existing health problems. Your doctor can discuss which are
optimal for you and your individual case.
Prevention is an important and possible means of managing gout and high
levels of uric acid. Below is a guideline for managing gout with diet
modification.
High Purine Foods (should be avoided)
Anchovies, Sardines, Scallops, Herring, Mackerel, Liver, Kidneys,
Brains, Game meats, Gravy
Moderate-Low Purine Foods (eat in moderation)
Asparagus, Cauliflower, Spinach, Mushrooms, Green peas, Lentils, Beans,
Oatmeal, Wheat bran, Wheat germ.
Alcohol, particularly beer, should be avoided.
Water helps to dilute urinary uric acid.
In general, a well balanced diet following the above guidelines and
maintaining a healthy body weight will significantly help to prevent
gout attacks if you are prone to developing them.
Article written by Dr. Corinne Gehegan
To schedule an appointment call (201) 840-7373.
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