Gout is caused by abnormal metabolism of substances called purines that result in the accumulation of uric acid in the blood stream. Purines are a by-product of cell break down. When the excretion of the uric acid is hampered the accumulated uric acid in the blood stream causes crystalline deposits to form in joints or in the soft tissues. When this happens, there is a sudden onset of extreme pain with associated swelling, redness, and increased warmth to the skin or joint. Classic gout occurs in the big toe joint. It also commonly occurs in the knee joint. Rarely is it seen in more than one joint at a time. Uric acid accumulation in other joints and areas of soft tissue is less common. When gout presents in these areas it, may not be recognized as gout by the treating doctor.
Diagnosis
As the crystalline deposits form in the joints and soft tissue, the uric acid levels in the blood stream can return to normal. Blood tests taken during an attack of gout may demonstrate a normal uric acid level. This can make diagnosis more difficult, and the physician must rely on his or her clinical experience to make the diagnosis. Other areas that gout may present itself are the tops of the foot, the heel and the ankle joint. In the chronic form of the disease, called tophaceous gout, the repeated deposition of uric acid will from nodules about the joints and tendons. These nodules can spontaneously open and drain a chalky like substance. An attack of gout can resemble an infection. An elevated temperature may also be present. This is worrisome to the physician because an infection in a joint can be a very damaging event. Some doctors may wish to take a sample from the joint so that it can be analyzed for gout and cultured for bacteria.
Treatment
Treatment often consists of both medications for gout and for infection. Immobilization of the foot with a removable cast or the use of crutches is useful. Once the proper medication is prescribed the symptoms of gout will start to subside quite rapidly. Left untreated the clinical course may take several days for the gout attack to subside.
Factors that contribute to the onset of gout are alcohol, red meats, asprin and certain medications for high blood pressure. Gout occurs most frequently in men. Women will not get gout until after menopause unless they have had a hysterectomy. Patients with long standing diabetes who may have kidney damage due to their disease, and patients who have kidney disease from other causes can develop gout. These patients may exhibit atypical forms of gout. In these instances, more than one area may be affected; the tops of both feet, for example, may develop gout.
Typically the onset of gout is sudden and intense. Frequently, the patient will go to bed feeling fine and wake up the next morning in excruciating pain. The attacks can become recurrent, and over time cause permanent damage to the affected joint (arthritis). Recurrent gout should be treated with medication to reduce the blood uric acid levels. The most common medication used is Allopurinol. This medication should not be started during an acute attack. If this medication is given during an acute attack it will make the condition worse. Acute attacks of gout are treated with a variety of prescription anti-inflammatory drugs.
