Gout is a disorder that causes sudden attacks of intense pain, swelling and redness in the joints or soft tissues. In many cases, the first attacks occur in the joints of the big toe, but gout can affect many other joints. It is a type of inflammatory arthritis. Gout affects approximately 2 out of 100 people in the United States.
Gout develops when too much uric acid accumulates in the bloodstream and forms microscopic spike-like crystals in joints or soft tissues. It can affect smaller joints, fingers, toes, elbows, instep, wrist, and ankle, and large joints, knee, and hip. The body reacts to uric acid crystals as if they were a foreign body or bacteria. White blood cells and other infection-fighting cells race to the area. The affected area can look like an infected area, red, swollen, hot, and tender. It is extremely painful and an attack can last for several days. Nine out of 10 gout guest patients rank their pain level as a nine or 10 on a pain scale.
What causes too much uric acid to accumulate? Uric acid is produced when the body breaks down purines, substances naturally found in the body, as well as in protein-rich foods such as steak and organ meats. High levels of uric acid are also in alcoholic beverages, particularly beer, and sugary drinks. Both yeast and fructose increase uric acid levels. In a research study conducted by Hyon Choi, MD, DrPH, clinical associate professor of medicine in rheumatology at Boston University School of Medicine, participants who consumed two or more sugar or fructose-sweetened sodas each day had an 85 percent increase in developing gout.
If uric acid levels remain high over a long period of time, deposits can develop around joints and tendons. The chalky deposits, tophi, look like white toothpaste and create visible lumps under the skin. When gout progresses over several years to this chronic stage, joints may have permanent deformities, persistent pain, and bone, cartilage and kidney damage. Most gout patient guests do not progress to this advanced, disabling stage.
Several factors put people at greater risk for developing gout:
- More common in men between the ages of 30 and 45
- Family history of gout
- Health conditions such as high blood pressure, diabetes or kidney disease
- Some medications
- Drinking too much alcohol, especially beer, and sugary sodas
It is important to come to Direct Orthopedic Care for diagnosis if experiencing gout symptoms. Gout is a chronic disease that worsens over time. With treatment, the disease may be controlled. Specific tests can help the DOC PA or physician make a diagnosis. A blood test can measure the level of uric acid in the blood. A high uric acid level strongly suggests gout, above 6.0 mg/dL.
In addition to following the DOC physician’s treatment plan, there are lifestyles choices to prevent gout attacks and future joint damage:
- A healthy body weight
- Drink plenty of water to help flush uric acid
- Avoid sugary drinks
- Avoid alcohol, especially beer
Treatment for gout focuses on relieving pain during acute attacks, preventing future gout attacks and reducing the risk of developing permanent joint damage. Medications can be prescribed to lower uric acid levels to reduce and prevent joint destruction. Long-term medications are typically prescribed to patients who have:
- More than three gout attacks a year
- Severe and disabling gout attacks
- Gouty joint arthritis
- Kidney damage or repeated kidney stones
People who develop destructive arthritis related to chronic gout may be helped with surgery. DOC patient guests should discuss options with their DOC orthopedic surgeon.
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