Gout is one of
the most common forms of arthritis or inflammation of a joint. It
most commonly affects the big toe joint (first metatarsophalangeal
joint), but can affect any joint. Gout usually starts as an acute
attack that often comes on overnight. Within 12-24 hours there is
usually severe pain and swelling in the joint.
|“Screw up the
vise as tightly as possible - you have rheumatism; give it another
turn, and it is gout” - Anonymous
usually only affects one joint at a time (sometimes two) - most
often the feet and ankles. The joint at the base of the big toe
is the most common site. If there is no treatment the gout attack
usually subsides in a week or so. After the first attack there may
be intervals of many months or even years before there are other
attacks. Over time these attacks tend to become more frequent and
more severe and eventually may involve other and more joints. Eventually,
without treatment, a state of chronic or continuous joint symptoms
may develop with progressive joint damage.
affects men and is very rare in women until after menopause when
it is seen quite often.
very painful. The joint becomes swollen and the skin over the joint
can be shiny or glossy in appearance.
The cause of gout is
related to the physiology of uric acid, which is a chemical that
is a natural part of the normal breaking down and building up
of food and body tissues. When uric acid levels are higher, this
is known as hyperuricaemia. Uric acid is normally dissolved in
the blood, but when its high, microscopic crystals may be deposited
in the joint. These crystals then set up the acute inflammation
causes the gout.
As a result of this
physiology, gout is common in those with hyperuricaemia. There
are many causes of this and include:
mainstay of gout treatment is correcting the factors that lead to
the high levels of uric acid. This involves a combination of diet
foods have higher levels of purines should be restricted or avoided:
- Offal foods like liver, kidneys, tripe, sweetbreads and tongue.
- Large amounts of red meat.
- Peas. lentils and beans.
- Alcohol intake should be reduced.
overweight is a risk factor, so weight loss may be very important.
High blood pressure (hypertension) is also a risk factor that your
doctor may need to address.
When an acute attack
of gout occurs, anti-inflammatory drugs (NSAID's) are usually very
effective to help gain control of the gout symptoms in the first
12-24 hours (these drugs have no effect at lowering uric acid levels).
Rest and elevation of the foot is also important.
Over the longer term, if diet changes
are not lowering the uric acid levels, drugs can be used to lower
the levels (these drugs have no effect during an acute attack).
The drugs must be taken on a continuous and long term basis if they
are to be effective. There are basically two kinds of drugs - one
increases the elimination of uric acid by the kidneys and the others
block the formation of uric acid.
management of gout:
There are a number of
thing that you can do to help yourself manage gout:
If the uric acid levels have been
high for a long time and acute attacks of gout has been frequent,
there may be deposits of uric acid around the affected joint (and
even elsewhere such as the ears) - these are called tophi. If they
are present, there is an even greater need for long term drug treatment
to lower the uric acid levels.
relevance to gout:
on foot problems
a question about gout in foot health forum
resources on gout
|USA & Canada:
|UK & Europe:
|Australia & NZ:
ePodiatry is purely
a source of information on gout, and should at no time be considered
as replacing the expertise of a health professional. We recommend
seeking professional advice for gout and all foot problems before
embarking on any form of self treatment or management of the gout.
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is intended to be relied on for medical diagnosis or treatment.
Do not delay in seeking health professional advice for gout because
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