Michael Piccarelli, DPM
1478 Victory Blvd
Staten Island, New York 10301
(718) 273-0123



WHAT IS GOUT?

Gout is a disorder that results from the build-up of uric acid in the tissues or a joint- most often the joint of the big toe. An attack of gout can be miserable, marked by the following symptoms:

• Intense pain that comes on suddenly- often in the middle of the night or upon arising

• Redness, swelling, and warmth over the joint-all of which are signs of inflammation

Gout occurs most commonly in the big toe because uric acid is sensitive to temperature changes. At cooler temperatures, uric acid turns into crystals. Since the toe is the part of the body that is furthest from the heart, it's also the coolest part of the body- and, thus, the most likely target of gout. However, gout can occur in other areas of the body, such as: ankle, foot, knee, finger, elbow, and wrist. Gout also may not always occur in the same joint.


WHO GETS GOUT?

As your uric acid levels rise, so does the potential for gout. There are also other factors that may affect your likelihood of experiencing gout:

  • Men, especially between the ages of 40 and 60, are more likely to develop gout than women.
  • Most women experience gout after menopause.
  • There may be a genetic link: many people with gout have a family history of the disease.
  • Gout rarely affects children or young adults.
  • People with certain conditions are at a higher risk for gout. These conditions include diabetes, high cholesterol, high blood pressure, obesity, surgery, chemotherapy, stress, certain medication and vitamins, and/or kidney problems.

WHAT CAUSES GOUT?

Gout attacks are caused by deposits of crystallized uric acid in the joint. Uric acid is present in the blood and eliminated in the urine, but in people who have gout, uric acid accumulates and crystallizes in the joints. Uric acid is the result of the breakdown of pruines, chemicals that are found naturally in our bodies and in food. Some people develop gout because their kidneys have difficulty eliminating normal amounts of uric acids, while other produce too much uric acid.

Consuming foods and beverages that contain high levels of purines can trigger an attack of gout. Some food contain more purines than others and have been associated with an increase of uric acid, which leads to gout. You may be able to reduce your chances of getting a gout attack by limiting or avoiding the following foods and beverages:

  • Shellfish
  • Organ meats (kidney, liver, etc.)
  • Red wine
  • Beer
  • Red meat

DIAGNOSIS OF GOUT

In diagnosing gout, the foot and ankle surgeon will take your personal and family history and examine the affected joint. Laboratory tests and x-rays are sometimes ordered to determine if the inflammation is caused by something other than gout.

 

TREATMENT

Initial treatment of an attack of gout typically includes the following:

  • Medications. Prescription medications or injections are used to treat the pain, swelling, and inflammation.
  • Dietary Restrictions. Foods and beverages that are high in purines should be avoided, since pruines are converted in the body to uric acid.
  • Fluids. Drink plenty of fluids each day, while aldo avoiding alcoholic beverages, which cause dehydration.
  • Immobilize and Elevate the Foot. Avoid standing and walking to give your foot a rest. Also, elevate your foot (level with or slightly above the heart) to help reduce swelling.

The symptoms of gout and the inflammatory process usually resolve in three to ten days with treatment. If gout symptoms continue despite the initial treatment, or if repeated attacks occur, maintenance treatment that may involve daily medication might be necessary. In cases of repeated episodes, the underlying problem must be addressed, as the build-up of uric acid over time can cause arthritic damage to the joint.

In some cases of gout, surgery is required to remove the uric acid crystals and repair the joint.



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