Dr. Peter Wishnie

How Do You Know If You Have Gout?

This article discusses gout and how it can be prevented and treated.

Do you enjoy consuming red meat, beer, red wine, excessive amounts of alcohol, rich sauces, seafood, organ meats, anchovies, herring, asparagus, and/or mushrooms? If so, you may be at risk of getting a gout attack. What exactly is gout?

Gout, a form of arthritis, is caused by a build-up of sharp, needle-shaped urate crystals in the joint. These crystals are responsible for the pain and inflammation associated with this condition. The increase in crystals is caused by elevated uric acid levels in the bloodstream. The foods listed above are rich in purines, which are also naturally found in the body, and these purines are broken down to uric acid. Under normal circumstances, uric acid is excreted through the kidneys and urine. When the body produces too much uric acid, a person consumes too much purines in their diet or the kidneys are not properly excreting enough uric acid, there is an excessive amount of uric acid leading to a gout attack.

How would you know if you have gout?

Typical presentation includes a person who wakes up in the middle of the night or in the morning with a sudden onset of a red, hot, swollen joint with no preceding injury or trauma. Gout most commonly affects the big toe joint in the foot. However, it can also affect other joints such as the midfoot, ankle, knee, elbow, hands and wrists. Initially with the first or second gout attack, the joint will appear normal on a standard X-ray. However over time with frequent gout attacks, the affected joint will have limited movement, a bony prominence and will appear as a damaged joint (arthritis) on an X-ray.

Who is at risk?

Men have a higher rate of sustaining a gout attack but menopausal women are also prone to this painful condition. Also those with uncontrolled high blood pressure, diabetes, increased cholesterol levels and heart disease are also susceptible to gout. Medications such as diuretics and low-dose aspirin also increase uric acid levels. Finally, a purine-rich diet of the above mentioned foods and excessive alcohol consumption can lead to a gout attack. Therefore, prevention includes limiting purine intake in the diet, limiting alcohol consumption, and being healthy and active.

How is it treated?

If you experience the symptoms of a sudden onset of a red, hot, swollen joint, call your doctor immediately. If you experience the attack in the foot or ankle, call your local podiatrist but if in other joints, you should call you primary care doctor, orthopedist or rheumatologist. If left untreated, you could develop firm nodules called tophi under the skin or kidney stones. Your doctor will take an X-ray of the joint, but as mentioned most likely the films will be normal especially with the first or second attack. Blood testing for uric acid is unreliable for gout. Definitive confirmation of gout involves obtaining joint fluid and having it analyzed for the presence of the urate crystals. Treatment consists of non-steroidal anti-inflammatory drugs (NSAIDs), a cortisone injection, oral steroidal drugs, and/or a medication called colchicine. If you experience recurrent gout attacks, you may be prescribed Allopurinol or Probenicid - long-term medications strictly to prevent future gout attacks.

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