Got Gout? How to Find Relief and Reduce Flare-Ups
What Is Gout?
If you’ve ever talked with someone who has gout, you probably heard it can be extremely painful. But what exactly is gout? Gout is a common metabolic disorder that results when uric acid builds up in the joint, causing pain and inflammation. Gout most often affects the joint of the big toe, although it can occur in any joint in the body.
Why the Big Toe?
Many patients ask “Why is my gout only in my big toe?” The answer has to do with temperature. The big toe is the coolest part of the body because it’s the farthest from the heart—and at cooler temperatures, uric acid turns into crystals. It’s this crystallized uric acid in the joint that causes a gout attack.
Too Much Uric Acid Causes Gout
Uric acid is present in everyone, even those who don’t have gout. Uric acid is a byproduct of substances that we eat and drink. These substances are called purines. Normally the uric acid that purines produce is eliminated in the urine. But in people who have gout, too much uric acid remains in the body—either because they produce too much or have a problem eliminating it. This excess of uric acid has to go somewhere, and that’s often the lining surrounding the big toe joint, where it becomes crystallized and causes a painful flare of gout.
Possible Reasons for Accumulating Uric Acid
Gout is a complex disorder, and there are many possible reasons why someone might accumulate uric acid in the body. People with a family history of gout have an increased likelihood of developing this condition. Certain medical conditions—such as kidney disease, high blood pressure, and obesity—are sometimes associated with a build-up of uric acid. Other potential factors that can increase uric acid levels in the body include certain medications and vitamins—such as diuretics, aspirin, and niacin. Stress can also negatively affect the ability to eliminate uric acid. Importantly, lifestyle choices relating to diet and alcohol play a critical role, and we’ll discuss that in the following slide.
Foods and Beverages That Can Trigger Flares
Certain foods can trigger a gout attack, because they contain high amounts of purines—the substance that converts to uric acid in the body. Because of this, diet is important and high-purine foods should be avoided to help ward off a flare of gout. Some foods that contain high levels of purines include shellfish, organ meats (such as kidney and liver), and red meat. In general, high-protein diets are also high in purine. Consumption of alcohol is also strongly linked to gout flares, because alcohol interferes with the body’s ability to eliminate uric acid. Since each patient is an individual, the specific trigger for gout attacks differs from patient to patient.
Who Gets Gout?
Who typically has gout? Gout is most common in men aged 40 to 60 years, but it can occur in any adult, at any age. Men produce more uric acid than women, although after menopause women’s levels of uric acid approach those of men.
Signs and Symptoms of a Gout Attack
The most disturbing symptom of a gout attack is intense, unrelenting pain in the large joint of the big toe. This severe pain comes on suddenly, often in the middle of the night or upon arising, and it usually lasts for about a day or two. Once the extreme pain subsides, there is typically lingering discomfort as well as inflammation. The signs of inflammation are redness, swelling, and warmth over the joint.
Seek Medical Help for Sudden, Intense Pain
If you experience sudden, intense pain in your big toe, see a foot and ankle surgeon for an evaluation and treatment. It’s important to deal with this condition as early as possible, because over time gout can damage the joint and lead to arthritis if it is left untreated or if multiple attacks occur.
Diagnosing Gout
In evaluating your symptoms and reaching a diagnosis, the foot and ankle surgeon will ask questions about your personal history as well as your family medical history. The surgeon will then examine the affected joint. In some cases, the surgeon will perform a needle aspiration procedure, which extracts fluid to see if it contains crystallized uric acid. Laboratory tests and x-rays are also sometimes ordered to determine if the inflammation is caused by something other than gout. Because other conditions, such as pseudogout, can be mistaken for gout, it’s important to obtain an accurate diagnosis.
Initial Treatment of a Gout Attack
The initial treatment of a gout attack typically includes four strategies: medication, dietary restrictions, fluids, and rest, ice, and elevation. Medication may include prescription anti-inflammatory drugs or steroid injections to treat the pain and inflammation. Dietary restrictions involves avoiding foods that are high in purines, as well as avoiding all alcohol. Drinking plenty of water and other fluids each day is important to prevent dehydration. The fourth treatment strategy, which will help reduce the swelling and inflammation, is to rest the foot by avoiding standing or walking, ice the affected area, and elevate the foot so it’s level with or slightly above the heart.
Unresolved Gout
If your gout symptoms fail to resolve after this initial treatment, or if you experience repeated attacks, make an appointment to see your primary care physician for maintenance treatment. This might involve daily medication that addresses the underlying problem that’s causing the repeated episodes. For many patients, however, initial treatment and continued lifestyle strategies that avoid their triggers keeps gout attacks at bay.