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OUCH! Gout!

Gout is a common and elusive form of arthritis that can cause painful swelling in your joints. Flare-ups can last anywhere from a week to multiple weeks.

What is Gout?

Gout is a type of arthritis that leads to significant inflammation and pain in the joints—most commonly in the lower extremities. A buildup of Urate crystals triggers it. Urate crystals come from Uric acid, which occurs naturally when the body metabolizes purines. The body expels Uric acid through urination. However, when a person is overweight, eats foods rich in purines, and drinks too much alcohol, the body produces too much Uric acid and cannot expel it efficiently.

The excess Uric acid turns into Urate crystals that settle in the synovial fluid of your joints, and inflammation manifesting in acute and chronic pain occurs. Gout can affect one or multiple joints. Some people only experience Acute Gout once or twice in their lifetime. Although quite painful, Acute Gout presents quickly usually clears up in 1-2 weeks. However, some people will experience Chronic Gout where repeated flare-ups occur. Chronic gout can have long-term effects on an individual’s kidneys and joints.

Purines

Some foods are high in purines. Purines are the most common chemical on earth. This natural substance break down into uric acid as food moves through our digestive systems. Normally, the body has no problem processing purines. But, when we consume large quantities of purine-rich foods, our bodies cannot metabolize the excess efficiently, resulting in a buildup of uric acid. Here are the most common foods that are high in purines:

  • Alcoholic beverages, especially beer and red wine
  • Shellfish
  • Anchovies and sardines, herring, codfish, trout
  • Bacon, turkey, veal
  • Organ meats

Gout in history

Documentation of ‘the un-walkable disease’ dates to 2640 BC. The term gout comes from the Latin word gutta, meaning ‘drop’ because they believed disease would drop into the joints, causing inflammation and pain. Throughout history, gout was associated with the rich and royal folk who could afford to eat large quantities of rich foods and alcohol. Gout was often referred to as the ‘disease of kings. At one point in the early 1800s, gout became a catalyst to raise one’s social status because of its association with decadent lifestyles and the ability to eat extremely rich foods and drink alcohol.

Symptoms of the Disease of Kings

Symptoms of acute gout can vary by individual. A person can go to bed with no symptoms and awake with painful swelling in their toes. Acute flare-ups can occur quickly and subside within a week or two.

The onset of gout most commonly presents in the joint of the large toe. It begins with redness, pain, and swelling. Occasionally, it may appear in the knee joint.

Swelling can continue for several days up to two weeks from the onset of symptoms. The pain and swelling often can impede one’s ability to put weight on their foot, thus making it difficult to walk without severe pain and discomfort.

The three most common symptoms are:

  • Redness around the involved joint
  • Swelling with some heat to the skin
  • Sharp pain that intensifies with pressure

Long term impact on your body

Patients with chronic gout will more likely be diagnosed with several other chronic conditions such as:

  • Kidney damage and kidney stones
  • Gout can also affect the joint bursa (sacs of fluid that help cushion muscles and tendons as they move over bone).
  • Tendon sheaths and fascia tissue can be affected by prolonged, high uric acid levels.
  • People who experience gout may be more likely to develop complications or other diseases like hypertension, diabetes, and congestive heart failure.

Treatment for Gout

Your doctor can provide an effective treatment plan after closer examination. Your unique condition will determine the best method of treatment. In general, there are four fundamental objectives to the treatment process:

  1. Prevention – prescribing a healthier diet low in purines, weight loss, abstinence of alcoholic beverages.
  2. Pain management – Reduce the amount of pain you experience through anti-inflammatory medications.
  3. Prescribing Colchine, steroid or non-steroid anti-inflammatory drug– medications that treat the inflammation caused by uric acid and urate crystals.
  4. Avoid future flare-ups – and tophi, prolonged elevated levels of uric acid, and urate crystals that form monosodium urate deposits in the form of lumps and masses in joints and tissues. Usually met with continuous use of Allopurinol (medication used to prevent increased uric acid levels).

What you can do to avoid gout

The most important action you can take to avoid gout is starting with your Primary Care physician’s visit. This visit should include accurate descriptions of your diet and alcohol intake. Once a comprehensive health assessment is established, your provider may recommend some lifestyle changes such as:

  • Reduce the amount of alcohol you drink
  • Weight loss
  • Exercise
  • Increase your water intake

Follow a diet recommended by a nutritionist or provider based on foods low in purines. Some common foods are:

  • Eggs, nuts, and peanut butter
  • Bread, rice, popcorn
  • Some fruits and vegetables
  • Skim or 1% milk

Final thoughts

See your Primary Care physician regularly—even when you feel fine. You can feel great one day and wake up in pain with gout. Having your doctor know about your dietary habits and overall health can help you avoid the potential risk of high uric acid levels. If it’s been more than 12 months since you saw your Primary Care physician or don’t have a Primary Care doctor, schedule an appointment today. Think Whole Person Healthcare can provide same-day appointments conveniently located in central Omaha.

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