Righttime Medical Care - Gout

A painful and swollen big toe may be a sign that you have common form of arthritis called gout. Gout occurs when you have high levels of uric acid in your blood. Uric acid forms when your body breaks down a substance called purines. Purines are found in some foods.

While most of the time uric acid leaves the body in urine, too much of it can build up and form urate crystals that accumulate in the joints. The buildup of urate crystals in the joint can cause pain and swelling the joints of the fingers, wrists, elbows, ankles or toes. The joint could feel warm to the touch. While it is not a life-threatening condition, gout can cause serious health problems if left untreated, like tophi, which are lumps of uric acid crystals that can form under the skin in and around the joints. These same crystals can form kidney stones.

Causes and Symptoms of Gout
Gout is a condition that can be caused by numerous factors. Historically it was called the “disease of kings” because it was associated with overindulgence in food and alcohol which at the time only the rich could afford. 

Factors that can cause gout include:

  • Purine-rich diet – Meats such as bacon, turkey, veal and liver are high in purines. Seafoods like sardines, herring, trout and haddock are also purine rich. Crabs, lobster and shrimp have moderately high purine levels. Alcoholic beverages such as beer, wine and liquor are also high in purines.
  • Obesity – Being overweight leads to higher levels of insulin circulating though the body. That prevents uric acid from being eliminated from the body.
  • Renal insufficiency –When the kidneys are unable to adequately filter waste from the body, uric acid can accumulate in the blood.
  • Diuretics – Using medications that relieve water retention can cause increased urination, reducing the amount of fluid in the body. The fluid that is left behind is more concentrated and can increase the risk of uric acid crystals forming and attacking the joints.
  • Immunosuppressant medications – People who have had organ transplants and are taking anti-rejection drugs may be more prone to gout.

The first symptom of gout that many people experience is excruciating pain, inflammation and swelling in the big toe. It can also appear in the ankles or knees. A gout attack may wake you up in the middle of the night with severe pain.  

How is Gout Diagnosed?
Severe joint pain —or a fever which is a sign there may be an infection — will be the signal that it is time to visit your doctor. He or she will review your medical history including the medications taken regularly, diet, frequency and severity of the pain and inflammation and what joints are affected. The doctor may take an X-ray or request an MRI to look at the tissues and bones. And in some cases, fluid may be removed from the joint and examined under a microscope for the presence of uric acid crystals.

Treatment for Gout
Typically there are two ways to treat gout. One is to reduce the pain and inflammation, and the second is to reduce the amount of uric acid in the blood.

Non-steroidal anti-inflammatory drugs (NSAIDs) like naproxen (Aleve®) or ibuprofen (Motrin® or Advil®) can help reduce the joint pain and swelling. Using an ice pack on the affected area and resting it also helps.  

Prescription medications that can reduce the uric acid content in the blood include Allopurinol (Aloprim®, Zyloprim®), Febuxostat (Uloric®), Lesinurad, Pegloticase (Krystexxa®), or Probenecid (Benemid®).

Ways to Prevent Gout
Preventing gout means embracing a healthy lifestyle. Eating a healthy diet that is low in purines, exercising to maintain a healthy weight and reducing or eliminating alcohol use are a great way to start. Remember to stay hydrated. Avoid sugary drinks and eat less meat. Get protein from low-fat dairy like yogurt or milk.



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