Contributed by Dr. Bright.
Sorry to hear about the recent problems that you have experienced with gout. Gout is definitely a painful condition that affects multiple joints throughout the body. Gout develops when affected individuals have difficulties eliminating uric acid from their body. Uric acid is a waste product from the normal turnover of cells in the body. Some individuals or unable to eliminate the uric acid efficiently leading to the buildup of uric acid. Uric acid then deposits into joints and other soft tissues as needlelike crystals. These needlelike crystals cause inflammation in the joint with resulting swelling, redness, and pain. The most common joint affected with gout is the great toe. Other joints can be affected and are frequently represent more peripheral joints. The affected joints are often further from the heart because the crystals are more likely to precipitate in areas of the body that are cooler.
It is estimated that 6 million adults over the age of 20 have experienced an acute gouty attack. Men are more often affected than women. It has also been shown that it is very rare for postmenopausal women to develop this disorder.
An acute gouty episode typically occurs suddenly with the onset of intense pain and swelling in a joint. I can recall my days in the hospital when patients would have to remove the overlying bed sheet from their great toe because the pain was so intense. An attack usually subsides within 3-10 days with or without treatment. People with a long-standing history of gout may experience attacks that last longer or occur more frequently.
The treatment of an acute episode is largely directed at alleviating the inflammation in the joint. Most commonly nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed to help alleviate the symptoms. Occasionally corticosteroids (prednisone) may be used. For individuals who have recurring episodes of gout your physician may obtain a blood test to determine the uric acid level. There are medicines that you can take to lower your uric acid level (allopurinol) and prevent recurrent attacks. Studies have shown that you are less likely to experience a recurrent attack if your uric acid level is less than 6.0.
If you have experienced an attack of gout I would recommend drinking plenty of fluids. Fluids can help to lower your uric acid level and prevent recurrent attacks. I would avoid alcohol as it can raise your uric acid level. Regular exercise and weight loss have been shown to decrease recurrences. People who suffer from recurring episodes may benefit from avoiding foods that are high in purines (anchovies, asparagus, dried beans and peas, gravy, liver, mushrooms, sardines, and scallops).
If your pain is persisting following an acute episode of gout I would recommend following up with your physician as there can be other causes for the joint pain. It is my experience that between episodes patient should not experience any symptoms.
Darrin Bright, MD
Max Sports Medicine