Gout is a common inflammatory arthritis that affects men more often than women. It is caused by an excess of uric acid, which is a by-product of purine breakdown. Since our bodies do not have the enzyme that breaks down uric acid as other animals do, humans then tend to have a excess of this. Called hyperuricemia, the excess uric acid gets deposited as needle-like crystals in soft tissue, bones and joints.

Not all people who have hyperuricemia go on to develop gout for reasons that are not well understood. Clinically, serum levels of uric acid can be slightly elevated yet still be within normal limits during an acute attack.  

The first attack of gout generally strikes the base of the large toe. Some reasons for this that have been postulated is that the extremities tend to be slightly cooler which causes crystals to form. Additionally it is felt that the large toe suffers mechanical microtrauma more easily than other joints because of its weight-bearing status. Since gout tends to form in joints that have been traumatized, this joint is commonly involved.

Sometimes however, the forefoot is involved or the elbow (think of excessive leaning on the elbow) as well as the wrist or finger joints. That is why it’s important for your provider to get a detailed history and do an inspection of your feet and other joints during your visit.

Gout generally strikes during night time hours again for reasons not well understood.  The pain can be so excruciating that the weight of a bed sheet can be too heavy. There is pain, swelling, heat and redness associated with the attack which, if not treated, will spontaneously resolve in 3 -10 days.

Gout tends to be a progressive disease so although another attack may not occur for years, damage may still be occuring as a result of crystal deposition in the affected area which can lead to joint erosion. When attacks are occuring more frequently, medication can be taken that will reduce the levels of uric acid since gout does not occur in the absence of hyperuricemia.

Be sure to talk to your provider about treatment options and possible dietary changes both during an acute attack as well as during the intercritical stage (the stage between attacks). For more information, read ”Gout – Causes, Stages and Treatment For This Inflammatory Arthritis“ and visit www.gout.com

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