Gout is a clinical condition involving severe inflammation of a joint, very often the great toe joint or any joint in the foot or ankle. This is the clinical manifestation of underlying hyperuricemia, or excess uric acid in the bloodstream. It is hallmarked by severe redness, swelling and pain, often occurring overnight and without any precipitating event. In this episode I will review the physiology of gout, and touch of treatment methods for early and late stages of this condition.
Gout is a term we use to describe the intense inflammatory episode that occurs when elevated uric acid levels in the blood - a condition called hyperuricemia - cause crystal deposition in the joints. Very often this occurs in the foot since this is a cooler area of the body. Patients will remark that even the sheets touching the joint elicits intense pain.
Clinically, we often see the great toe joint involved. This is probably due to several factors, including that underlying arthritis is often present before a gout episode occurs. Additionally this is a relatively large joint in a cool area of the body.
Diet may play a role. Specifically, foods high in purines will contribute to hyperuricemia. Shellfish, dark flesh fish such as salmon and tuna, red meat and derivative products such as gravy, even beans and peas may elevate systemic uric acid levels. Additionally, dehydration may compound the elevated uric acid levels, such as with consumption of alcohol or when taking diuretic medication.
With blood tests we can determine the levels of uric acid and consider either diet modification for transient or slightly elevated uric acid or long term medication for very high levels. These medications will lower the uric acid and thus indirectly reduce or eliminate gout attacks.
Gout as an inflammatory condition is manageable, but clinical evaluation is essential. Each attack is not without consequence and multiple attacks over time can lead to severe debilitation, sometimes requiring surgical management.