Gout is an extremely painful joint disorder that usually affects the great toe joint of the foot. It is commonly seen in my practice.
Classically, I will see patients visibly limping into the office unable to place any weight on the affected foot. The joint is red, hot, swollen and extremely painful when touched. Some patients experience so much pain with this disorder that a bed sheet touching this toe causes severe pain.
What causes gout?
Gout is caused by increased levels of “uric acid” in the body. Uric acid is a byproduct of purine metabolism.
There are multiple factors that can cause in increase in uric acid in the body. This include:
- Trauma or injury
- Surgery
- Starvation
- Fatty Foods
- Other dietary triggers
- Dehydration
- Certain drugs (like blood pressure medications – thiazide and loop diuretics)
- Vaccination
Alcohol is strongly implicated in the development of a gout attack in patients who have a history of increased uric acid levels.
What does gout look like?
Gout will present as an extremely painful red, hot and swollen joint. Usually only one joint is affected but in chronic cases multiple joints can be painful.
An acute attack is so painful that is it extremely difficult to walk on the foot.
How to diagnose gout
It is best to see you doctor for a thorough medical examination to figure out the root cause leading to this attack. As described above, an increase in uric acid can be cause by a variety of factors including certain medications (blood pressure medications, chemotherapy) and dietary considerations.
Gout can be established through a thorough history and physical examination. Two other methods that can assist with diagnosis include examination of joint fluid under a microscope (the gout crystals can be seen!) or with blood work to check uric acid levels in the blood.
Uric acid levels can be measured in the blood but this test is typically not helpful during an acute gout attack. The reason for this is because uric acid levels will normally be lower than baseline during an attack. It is best to wait 1-2 weeks after an attack to measure uric acid levels in the blood.
Why it is important to seek medical evaluation?
It is important to see a doctor with suspected gout to make sure you have an accurate diagnosis. It is important to differentiate gout from other disorders like a joint infection (septic arthritis), trauma (get an x-ray to rule this out!), other types of infection (like cellulitis which is infection of the skin or osteomyelitis which is an infection of the bone), and other forms of arthritis. Each of these disorders are treated differently.
How to treat gout
As discussed above, first the diagnosis needs to be established.
A variety of treatment options do exist. An acute attack can be treated with various medications like anti-inflammatories, steroids or colchicine. Sometimes an injection of steroid into and around the joint can be helpful.
Repeated attacks with higher uric acid levels need long term treatment. Dietary modifications can only be of limited utility in these case. Typically a medication will need to be prescribed to lower chronically elevated uric acid levels in the blood to prevent future attacks.
Reducing high uric acid levels in the blood not only will reduce the likelihood of future gout attacks but will also reduce overall body inflammation, reduce the formation of kidney stones and prevent joint destruction.
I have been diagnosed with gout, what diet should I follow?
Large amounts of protein intake and certain seafoods can precipitate gout attacks (like red meat and shellfish).
If you are overweight/obese it is absolutely imperative to lose weight.
A healthy diet consists of large amounts of fruits, vegetables, grains and low-fat dairy products. It is important to remain hydrated with plenty of water.
Limit sugary drinks and alcohol.