A word about: Gout

by admin on October 7, 2011

Here in Missoula, it turned rainy and cold suddenly three days ago, signaling that the Autumn 2011 is here to stay. The change in weather signals the trees to change their leaves’ color, animals to begin preparing for winter, and in Missoula the students are back in school, fishermen are making their last casts, and sportsmen and ramping up the hunting season. In my office, the change in weather that marks fall tends to bring a particular ailment through the door that was not so common just a few weeks ago: Gout.
I chose to write about Gout for this entry because there seems to be a lot of misinformation our there about the disorder. As an ailment, it has been known about for centuries, especially as it tended to have high-profile victims like kings and wealthy businessmen. Alhough it has been known about for a long time, however, it seems that still few people know much about it. I have heard gout blamed for everything from broken ankles to ingrown toenails; most of the time Gout never had anything to do with it. Gout is a specific disorder of the joints, a type of temporary arthritis that, although extremely painful, can be easily treated.
What is gout? It is an inflammatory arthritis that occurs in specific joints because uric acid crystals formed inside the joint lining. The uric acid got there because levels were high in the bloodstream and so some leaked out into the joint fluid. Now, below a certain temperature, the uric acid that normally is liquid in our blood will turn solid and form crystals. In the summer, we are warm, and the uric acid stays liquid. Once the weather changes, however, the extremities become cooler than our core temperature, and the gout crystals form. The crystals are like shards of glass in the joint, and cause injury to the joint lining, which also is full of nerve endings. The injury sets off an inflammatory response, and you have full-blown Gout.
What does it look like? Gout typically affects one joint at a time, and in the body the most common location is the big toe (or 1st metatarsal-phalangeal) joint. The affected joint will be red, swollen, and extremely painful; often the touch of socks or even bedsheets can cause intense pain. Often, swelling will involve the whole foot. Other times, it is only swollen around the specific joint. The redness is a well-defined, cherry red. The symptoms can literally crop up overnight, and without warning.
Why do people get it? Gout happens when the levels of uric acid in the bloodstream are too high. Uric acid is a product of our bodies’ natural metabolism, specifically compounds called purines (pyoo-reens), which are found in high levels in things like meat, cheese, beer, and wine. Historically, it was the diets of the rich and famous that made them natural targets for gout. In more modern times, though, the explanation is not so simple. Some people seem to get high uric acid levels no matter what they eat; this is usually due to a particular function of the kidney working less-efficiently than it should. Other people seem to have a lower threshold then others in regards to how much uric acid is necessary to cause gout. Certain medications, also, can cause an increase in levels of uric acid in the blood. Generally, the reason for a gout attack is not obvious, and finding out the exact cause usually takes a little homework on the part of your physician.
As a side note, gout statistically affects more men than women, simply because gout attacks in pre-menopausal women are almost unheard of. The reasons for this are still unclear.
How is it treated? Gout is typically treated with oral medications. Even if you immediately correct the cause, gout still will linger on for days as the body has to break down and remove the gout crystals through action of the white blood cells. Treating the extreme pain, as well as the swelling, usually requires anti-inflammatories to help dull the sensitivity of the joint while the problem is being worked out. (This is a rare case when ice, the natural anti-inflammatory, doesn’t work – remember, cold is what started this problem in the first place.) The most effective medication, colchicine, prevents the joint from reacting entirely, and used to be the gold standard of treatment. Unfortunately it has been re-patented by a third party and is now sold as a name-brand, and expensive, medication. (There are ways around this, but I can’t reveal my methods on this blog.)
The best treatment for gout, like most things, is prevention. A single gout attack might be a freak occurrence, the result of enjoying yourself too much at your cousin’s wedding. A gout attack could also signal metabolic problems which may or may not relate to your overall health or other health problems. Certainly, if you suffer a gout attack you will want to seek medical treatment; you probably will barely be able to walk. Don’t just take the medications, though, and forget about it. Follow-up, and often a visit with other specialists like a rheumatologist or nutritionist, can help prevent painful episodes and other effects of gout in the future.
Now that you know, stay warm, stay smart, and avoid the gout! Enjoy the fall.

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