He was 43. He presented wearing a house slipper because he could not wear a regular shoe due to the pain in his big toe joint. “I woke up this morning and it hurt so bad I could barely put weight on it and could not wear my “regular Shoes”
Gout is a condition in which the body has a problem in the handling of uric acid. People with gout either produce too much uric acid or have a problem removing it. There are a number of possible consequences of this buildup of uric acid in the body including acute and chronic gouty arthritis, kidney stones and deposits of uric acid in other tissues. Gout may occur alone or associated with certain medical conditions or medications and referred to as secondary gout.
Gout should be considered as a possible diagnosis in people who have a sudden onset of a hot, red, swollen joint. The most common join involved is the great toe joint but other joints can be involved as well. In some people, the acute pain is so intense that even a bedsheet cannot be tolerated on the area.
Initial attacks can resolve spontaneously after one or two weeks but because of deposits of gout crystals, the same joint will generally be affected on repeat attacks. With time, attacks become more frequent and tend to last longer and often times can involve more than one joint. Gout crystals cause permanent damage to joints but gout crystals can form outside the joint also and collections of these gouty crystals are called tophi. These can be found throughout the body including the ear lobe, elbow, Achilles tendon and other affected joints/Areas. Sometimes these areas will open and drain watery drainage and what appears to be cottage cheese from the wound. If left untreated the continued attacks and accumulation of crystals will damage the joint and lead to chronic, gouty arthritis. Because the appearance of the symptoms can also be an infection in the joint, medical attention should be sought when you have a gout attack. After more than one or two attacks, you may need to get on a prescription medication to prevent further gout attacks.
Gout is caused by the accumulation of uric acid which is generated as the body tissues are broken down during normal cell turnover. Most people do not effectively eliminate their uric acid via the Urine (90%) while the remainder of people over produce uric acid. Your chances of having gout is about 20% if your parents have it. Alcohol, especially beer, increases the risk of gout, shellfish and diets rich in red meats, internal organs, yeast and oily fish. Gout is more common for men ages 30 to 50 while women it is more common in ages 50 to 60. There are other causes of gout such as injury, starvation and dehydration, chemotherapy and often times by medications such as water pills and high blood pressure medication.
Once you believe you have a gout attack you should seek medical attention and will likely have a blood test drawn to determine your uric acid levels as well as your blood counts to help determine what is causing the inflammation. The best way to determine if in fact you have a gout attack or not is by joint aspiration which is achieved by inserting a needle into the joint to withdraw a sample of the fluid for testing. This is very painful. Most commonly, blood tests are used but if the test is done too long after the attack, the test will be normal as the body has deposited the excessive uric acid into the affected joint and blood levels will return to normal. X-rays are often taken and are primarily used to determine the joint damage, especially when multiple attacks have occurred.
Treatment involves anti-inflammatory medication, steroids and A medicine called colcrys specifically used for Gout. These all have their indications and what is best for you will be determined by your treating provider. Steroid injections into the affected area or joint can give very quick resolve of the complaint and pain.
So, if your toe turns bright red and swells with intense pain, you may have gout. It is important to follow up with your podiatrist immediately when the gout attack starts to better address the problem and resolve your pain faster.