What Causes Gout?

"Gout is caused by an increase, or build up, of uric acid in the body.  It is usually a result of a decreased excreation of uric acid in our urine.  Initially the uric acid is found in the blood, but over time it will defuse throughout the body.  This includes the joints.  As uric acid increases in concentration in the joints it is more likely to crystallize.  These crystals can cause a lot of pain during an acute gout attack. 
 

The question can be asked: Why is gout usually seen in the feet?  Uric acid is not water soluble.  This means that it will crystallize if given the right conditions.  First, in high enough concentrations it can crystallize.  Second, as temperature decreases it is more likely to crystallize.  Gout can be found in any joint, but I believe it happens more in the feet because of the decreased temperature found in the feet.  The feet are the structures in the body that are furthest from the heart, making them the coolest. 

Symptoms of an acute gout attack include pain, edema (swelling), and erythema (redness) around the joint involved.  It is common to see a patient that was drinking alcohol or eating a steak dinner one evening to wake up the next morning with an acute gout attack.  The pain is usually 10 out of 10 and can be so painful it hurts to even let the bed sheets rest on the affected area.  An acute gout attack can mimic different arthritic conditions, including septic arthritis.  A diagnosis is made definitively through joint aspiration, which is then sent to a pathology lab."

- Dr. Marshal Gwynn

Got Gout?

Got gout? If so, here is a recommendation for reducing you pain and discomfort! Watch what you eat and drink. Changes in diet, including overindulging in certain foods and beverages can cause gout attacks.

Gout attacks are extremely painful, they are caused with uric acid accumulates in the tissues or a joint and crystallizes. This most commonly occurs in the big toe joint because the toe is the coolest part of the body and uric acid is sensitive to temperature changes. Foods high in purines contribute to uric acid build up. People prone to gout attacks should avoid purine-rich items such as shellfish (shrimp, crab, etc.), organ meats (kidney, liver, etc.), red meat, red wine and beer. Gout can be treated with medications, diet changes and increasing consumption of appropriate fluids. In some severe cases surgery is required to remove uric acid crystals and repair the joint. For more information on gout, visit our website at www.ShenandoahdPodiatry.com.

Gout

Gout is a common disorder of uric acid metabolism. It is a medical condition that usually presents with recurrent attacks of acute inflammatory arthritis. Gout is caused by cellular reaction to uric acid and can lead to deposits of monosodium urate crystals in soft tissues and joints.



Types

Primary gout - May occur alone. Accounts for about 90% of cases of the disease.

Secondary gout- May be associated with other medical conditions or medications. Accounts for about 10% of cases of the disease.


Frequency
Approximately 1% of the general population have gout.

Sex
Predominance- 90% male


Symptoms

Gout is associated with considerable pain.

Acute episodes of gout may incapacitate a patient.

Involved joints typically have the following symptoms: swelling, warmth, erythema, and tenderness.

The first metatarsal phalangeal joint is most commonly affected, however other joints can be involved such as the ankle or the knee.


A tophus deposit may develop in the ear.


Causes

Conditions that may cause acute changes in the level of uric acid and may precipitate a gout attack:

• Hyperuricemia
• End-stage renal disease
• Alcohol ingestion
• Disorders that cause high cell turnover with release of purines
• Over consumption of foods high in purines
• Underexcretion of uric acid - renal insufficiency

Long Term Effects

Untreated chronic tophaceous gout can lead to severe joint destruction.

Deposition of uric acid crystal in the kidneys may produce renal failure or obstruction.


Differential Diagnosis

Cellulitis- A severe inflammation of dermal and subcutaneous layers of the skin.

Gonococcal Arthritis- Is caused by infection with Neisseria gonorrhoeae.

Calcium Pyrophosphate Deposition Disease- Is a type of arthritis caused by the deposition of calcium pyrophosphate crystals.

Rheumatoid Arthritis- Is a chronic systemic inflammatory disease that affects the peripheral joints.

Psoriatic Arthritis- Is a chronic inflammatory arthritis that is commonly associated with psoriasis.


Laboratory Studies

Synovial fluid- The physician may aspirate the involved joint to rule out an infectious arthritis and to confirm a diagnosis of gout.

Serum uric acid.

Uric acid in 24-hour urine sample.


Imaging

Routine radiographs reveal punched-out erosions or lytic areas with overhanging edges. These finding are not acute.



Treatment

Acute gout

• Indomethacin- is the traditional Nonsteroidal anti-inflammatory drug (NSAID) of choice for acute gout.
• Colchicine.
• Corticosteroids- May be indicated in those patients who do not tolerate NSAID or Colchicine.

Chronic gout

• Probenecid- For patients who are hypoexcreters of uric acid.
• Allopurinol- For patients who are over producers of uric acid. Allopurinol reduces the generation of uric acid in the body.
• Uloric- Prevents uric acid production and lowers elevated serum uric acid levels.

Diet

Patients with gout should avoid beer and hard liquor. These elevate levels of uric acid and may precipitate attacks of gout.

High purine foods should be consumed in moderation:

• Kidney
• Liver
• Meats
• Shellfish