Galvanizing Against Gout
Pain radiates from your big toe to your ankle. You didn’t break or strain anything. Could you have gout?
Gout is an arthritic condition involving needle-like crystals that deposit in the joints, causing swelling and extreme pain. The crystals are uric acid, which is a normal waste product of the body. Uric acid is normally filtered out of the body by the kidneys and is eliminated as urine. In patients with gout, the level of uric acid rises above normal, and crystals deposit in the ligaments and cartilage. The crystals cause pain and inflammation, which is why we consider gout a type of arthritis.
The joint most affected in gout is the big toe, though other joints may also be affected, such as the knee, ankle, foot, hand, wrist and elbow. Gout affects more men than women and is often inherited.
Gout is one of the few conditions where the causes have been determined. Besides elevated levels of uric acid, other causes of gout include alcohol abuse, certain foods high in purines (such as certain meats, seafood, dried peas and beans), surgery, crash diets and severe illness.
Gout may appear spontaneously or be the result of surgery, being overweight, or excess cell destruction associated with diuretic drugs or chemotherapy. While there is no cure for gout, attacks can be controlled with medication and diet.
Often flaring up suddenly, symptoms of gout include:
§ Uric acid crystals in the joint fluid
§ Redness, tenderness, warmth and swelling around the affected joint
§ Pain in the joints
§ Mild fever
Blood tests will usually reveal an abnormally high level of uric acid.
One of the many mysteries of gout is that the attacks can go away completely after just a few days. This feature distinguishes gout from other forms of arthritis. And some people may not have another gout attack for years.
But the attacks can also become more frequent and longer-lasting. When that happens, gout can lead to the development of tophi (stone-like deposits of monosodium urate in the soft tissues, synovial tissues or in bones near the joints). Made of uric acid crystals, these large, visible nodules are disfiguring and may erode bone.
Gout can also lead to kidney trouble. When uric acid crystallizes in the urinary tract, kidney stones can form. The good news is that gout is both preventable and treatable.
Another condition, pseudogout (meaning “false”) shares many attributes with gout. In pseudogout, the crystals that deposit in and around the joints are calcium pyrophosphate. People do not form these crystals by taking too much calcium. It is a quirk that happens without explanation. Pseudogout usually picks on the knees and wrists. The nature of a painful, swollen joint is often detected by examining the joint fluid with a microscope. Pseudogout crystals are quite distinct from gout crystals.
The standard treatment for gout is a drug called colchicine. Though very effective, colchicine causes nausea, vomiting and diarrhea. Many prefer a nonsteroidal anti-inflammatory drug (NSAID) such as indomethacin for pain relief during an attack. Steroids may be used for the most severe attacks. Other drugs may be prescribed to control uric acid production and equally to increase the output of uric acid. These medications are powerful and have side effects that you should discuss with your doctor. A physician may arrange for your joint to be aspirated (drained) to test the fluid for uric acid crystals.
Rest, relaxation, proper diet and exercise and weight management can all help in reducing the effects of gout and any other type of arthritis. Exercise is important to keep the body healthy. Your doctor may recommend exercises that don’t aggravate gout symptoms such as walking or swimming. This will help you maintain a normal range of motion, keep joint cartilage well-lubricated and strengthen the muscles around the joints.
It is important to remain optimistic about your treatment program. Most of all, try to be patient. The more active a role you play in the management of your treatment, the better control you will have over your disease.
