Often times, podiatrists are the first to diagnose gout.  I thought it might be helpful to get a basic knowledge of what to look for and how to handle it.

An acute gout attack is an inflammatory process that occurs in a joint secondary to a high concentration of uric acid in the blood.  It is most commonly seen in the middle age, the elderly, and is much more common in men.  Theoretically, it can occur in any joint in the body but is most common in the big toe joint followed by the knee and the ankle.  It is extremely painful and is characterized by a red, hot, swollen joint.  Patients who are undergoing acute gout attacks are usually in extreme pain and find it most difficult to even bear weight during normal walking.

What causes it?

An acute gout attack results when elevated levels of uric acid in the blood cause crystals to settle into certain joints.  The body’s defense mechanism tries to fight the foreign material and an inflammatory process is initiated.  Uric acid is a metabolic end product that is normally found in certain foods.  People that experience “gouty attacks” have increased levels of uric acid for a variety of reasons.  Often, very rich foods like alcohol, chocolate, seafood, and meats can precipitate attacks.  The uric acid crystals settle in joints in one’s arms and legs because of the decreased temperature seen in the extremities.  The crystals are recognized as foreign material and the body fights it like an infection.  The area becomes swollen, red, hot and extremely painful.  Often times, a person in an acute gout attack cannot even tolerate the bed sheets touching the affected area.

How do you treat it?

Acute gout attacks are usually treated with a combination of therapies.  Oral medications such as anti-inflammatories, analgesics, and colchicine are most commonly used to treat this disorder.  Often times, local injections into the affected joint will help relieve symptoms.  Various other treatments include warm compresses, elevation of the involved area, physical therapy, and the use of pain relievers such as narcotics.  The goal of treatment in acute gout attacks is to end the “flare up” and convert the patient’s condition to the chronic state.  Certain oral medications are available on a long-term basis to help prevent recurrent attacks and possible systemic damage.

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