Although drinking alcohol or eating “trigger” foods such as seafood sometimes induces gouty attacks, it’s not always the case! Gout can be triggered by various other factors including injury, infection, and crash diets – an attack may not always depend on what you’ve eaten, however it is always related to the levels of uric acid in the blood.
Gout is a form of arthritis that can be extremely painful in its most acute state when patients are suffering from a flare. It falls into the category of arthridities because when uric acid levels are high gouty crystals settle in joint spaces, typically the big toes or the elbows, and induce boney changes, ultimately affecting the function of the joint. There may be a genetic link, but post-menopausal women and men between the ages of 40 and 50 are more likely to suffer from gout. Children are rarely affected.
High uric acid levels do not cause symptoms in every individual; some patients are able to handle high levels and never develop symptoms, nor do they develop flares. However, in patients with a predisposition, for whatever reason, high levels of uric acid (greater thank 6.0 mg/dL) induce pain, inflammation, warmth and redness around the affected joint(s). The pain comes on suddenly and can be so severe that even bed sheets cause a discomfort! Often times, crepitus (the sound of rice crispies) can be heard and felt when the joint is mobilized. Crepitus is the movement of the uric acid crystals within and around the joint!
At the first sign of a gouty attack in the lower extremity, you should seek treatment from your Podiatrist rather than suffer through the pain. To help confirm your diagnosis they may want to send you for blood work to measure the uric acid levels in your blood in addition to taking a sample of fluid from the affected joint. Your Podiatrist may also take x-rays of the affected toe joints, as uric acid deposits can be seen on plain x-rays.
In addition to using such diagnostic tools, gout provides a very distinct clinical presentation and it is very likely that your Podiatrist will immediately try to treat your flare and decrease your discomfort. There are a variety of options that can help decrease an acute attack including a steroid injection into the joint and/or an oral anti-inflammatory medication, such as Indomethacin, to decrease inflammation and subsequent pain. Immediate treatment, in addition to decreasing symptoms, can also help decrease the long-term affects on the involved joint(s). Once the initial attack has been treated and uric acid levels return to normal, preventative medications are not necessary for one-time sufferers.
However, patients who have suffered from multiple gouty attacks and are predisposed to flares may be given a medication to take daily. Your Podiatrist will determine the best medication for your long-term control based on whether you are an “over-producer” of uric acid or an “under-excreter” of uric acid. The idea behind a daily medication is to maintain “normal” levels of uric acid in the body, thus lowering your risk of subsequent gouty attacks. It’s important to keep in mind that even at times when you’re not experiencing a flare, uric acid levels may still be elevated in the body, and joint damage can still take place!
As mentioned, the food you eat may not contribute to a gouty attack, but it can! Gout used to be known as the “Disease of Kings” because of its association with rich foods that Kings typically had access too. Foods that are high in purine (the chemical responsible for producing uric acid in the body), such as red meat, seafood, spinach, alcohol, mushrooms, and oatmeal, to name a few, should be kept to a minimum in patients predisposed to gout or gouty attacks. Gout has also been linked to medical conditions such as hypertension (high blood pressure), diabetes, hyperlipidemia (high cholesterol) and atherosclerosis (narrowing of the blood vessels), so it is important to manage your co-morbidities with your primary care physician in addition to keeping a good watch on your diet to limit your flares!
