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Reach out and Read with your doctor’s office

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By Dr. Katherine Jett

Ouch!  My big toe is red and hurts!  It was fine last night, but now it is very painful.  This description could fit an infection or an injury to the toe, but it is also the classic presentation of gout.  Gout is a painful condition caused by high levels of uric acid that cause urate crystals to form. 

The crystals most commonly are deposited in joints, but can also be deposited in the kidney and cause kidney stones.  The big toe is the most common place for the crystals to cause problems because the temperature of your feet is usually lower than the rest of the body and this allows the crystals to form more easily. 

Gout has been called the “Disease of Kings” because people have often linked it to the kind of overindulgence in food and alcohol that only the rich could afford.  However, gout can strike anyone and is estimated to affect two percent of the United States population.  It usually first develops in men between ages 30 and 45 and women between ages 55 and 70.  The older you get the more often gout occurs. 

Obesity, high blood pressure, recent surgery, consuming excessive amounts of alcohol, overeating, and eating a diet with large amounts of meat, seafood, and regular sodas are all risk factors for developing gout.  Some water pills can also increase the risk of gout.

Gout attacks cause sudden and severe joint pain, often with redness, swelling and tenderness of the joint.  It usually affects only one joint at a time, but occasionally a person may have a few inflamed joints.

The pain is the worst within several hours and resolves in a few days to weeks.  The pain is caused when the body’s immune system tries to clear the urate crystal deposits. 

The diagnosis of gout is made by obtaining fluid from the affected joint and looking under a microscope for the crystals.   Other criteria for diagnosing gout include:  Pain and inflammation involving one joint at a time, especially the joint at the base of the large toe; Complete resolution of symptoms between attacks; Blood testing showing high levels of uric acid

The goal of treatment of flares of gout is to reduce pain and inflammation in the safest and quickest manner.  Anti-inflammatory medications are the most common class of medication used to relieve the symptoms of gout.  In more severe cases more than one medication may be necessary.  The treatment plan for each patient is individualized based on factors such as kidney health, risk of bleeding, history of stomach ulcers, and history of diabetes.  Patients that have recurrent episodes of gout require a more comprehensive approach to prevent progressive damage from the gout flares. This includes diet changes and daily medicines to lower uric acid levels in the blood.  A low fat diet and weight loss can help.  Vitamin C and coffee may also help slightly decrease uric acid levels. 

Don’t let gout cause havoc in your holiday schedule.  If you have pain or swelling in a joint get it checked out right away.  With proper treatment the symptoms can be resolved much faster.  Enjoy the Christmas season!