Anyone who has had an attack of gout knows that the symptoms are difficult to ignore. When gout affects the foot, the usual signs are a red, hot and swollen big toe joint that is exquisitely painful and sensitive to even the lightest touch. Gout is caused when uric acid, a normal product of metabolism, deposits into joints or other tissues and results in an inflammatory reaction. When gout affects a joint such as the knee or big toe joint, it is known as gouty arthritis.
- Gouty arthritis most often occurs at the first metatarsal phalangeal joint, or big toe joint.
- Gout predominantly occurs in people over the age of 30, men more often than women.
- Attacks usually worsen at night and symptoms may be so severe that they interrupt sleep.
- Symptoms can persist for days.
- Other areas where gout can occur are the hand, knee and ankle joints plus soft tissue areas such as the ear lobes or around tendons.
Facts About Gout:
What Causes Gout and Who Is at Risk?
There are a variety of risk factors that cause a person to either produce too much uric acid or fail to excrete it properly. And having a high uric acid does not always mean a person will develop a gout attack -- a person may have uric acid crystals in their joints and not have the inflammatory reaction that brings about pain and other symptoms.
Risk factors for elevated uric acid, also known as hyperuricemia, include:
- Alcohol abuse
- Use of diuretic drugs (water pills) and other drugs such as aspirin.
- High Blood Pressure
- Kidney disease
- Diabetes/insulin resistance
- Dehydration or extreme muscle exertion
- Certain diseases such as leukemias, hemolytic anemias and psoriasis
- Excess fructose consumption or hereditary fructose intolerance
Diagnosis and Treatment of Gout
Gouty arthritis most often presents as a red, hot, swollen and painful big toe joint. It is always best to seek medical attention if these symptoms develop in order to rule out an infection, which would require immediate medical attention. Gout is diagnosed by obtaining a sample of fluid from the joint via needle aspiration. The sample is sent to a laboratory, where it will be examined for the presence of uric acid crystals. Blood tests may also be done to check for elevated uric acid levels. X-rays may be taken to identify any damage to bone that may be present.
Treatment may involve medication to alleviate pain and inflammation such as non-steroidal anti-inflammatory drugs (NSAIDS)or cortisone. Your doctor may also prescribe medications to reduce uric acid levels in the body.
In some people, chronic untreated gouty arthritis may result in damage to the bone and cartilage within the joint. Another long-term consequence of gout is the presence of tophi in the joint or soft tissue. Tophi are lumps of uric acid crystals that have deposited in joints or around tendons.
In addition to getting medical care when gout strikes, it is best to rest the affected area. Keep the foot elevated often and decrease activity until the pain resolves.
One of the strongest risk factors for developing gout is obesity. In fact, a study referenced in the Archives of Internal Medicine found that weight loss offers some protection against the risk of developing gout in males.
Choi, MD DrPH, Hyon K., Atkinson, MD, MPH, Karen, et. al., Obesity, Weight Change, Hypertension, Diuretic Use, and Risk of Gout in Men. Archives of Internal Medicine. 2005;165:742-748.
Schumacher, Jr., MD, H. Ralph, Ed, Klippel, MD, John H., Assoc. Ed, and William J. Koopman, MD, Assoc. Ed. Primer on the Rheumatic Diseases. Tenth Ed. Atlanta: Arthritis Foundation, 1993; 209-215.