Gout is a painful foot condition that usually affects the big toe area. It is characterized by inflammation, redness, and stiffness of the joints affected. The condition is actually an attack of acute inflammatory arthritis. The metatarsal-phalangeal joint, which is at the base of the big toe, is the area which is most commonly affected. However, other joints of the foot can be affected as well. It is rare in persons under 40 years of age, although 6 million adults over age 20  have had the condition at some point. Men between the ages of 40 and 50 are the most likely to have gout. Women typically don’t develop the condition until after the onset of menopause.

Acute gout

Acute gout

The physical cause of gout is excessive levels of uric acid, a waste product, in the blood. This waste product is deposited in the joints and soft tissues as needle-like crystals. These crystals cause the inflammatory arthritis and its associated symptoms. The affected joint is usually very tender and swollen, making walking and standing painful at times.

The gout condition can develop due to a number of factors. One of these is genetics. Estimates vary, but around half of reported gout cases are people with a family history of the condition. Diet is a big contributing factor as well. Purine-rich foods can cause gout to develop or intensify. Some of these foods include wild game, some seafoods, asparagus, anchovies, mushrooms, and liver. Excessive alcohol use can interfere with removal of uric acid and lead to gout in some people. Other health conditions can play a role as well, such as high blood pressure, skin conditions, and thyroid gland issues. The medications used for some of these conditions can put some people at higher risk as well.

Acute gout attacks can be triggered quickly and become quite problematic. They often happen at night when the body temperature is lower, and are often a result of stressful events or a byproduct of other illnesses.  Intense pain and swelling of the joints around the big toe is common, and the area feels warm and is quite tender. Acute gout attacks usually last for up to 10 days, and usually subside of their own accord. However, subsequent attacks can last much longer, and intensify each time they occur. The period of time between attacks can be months or years, but eventually they tend to last longer and occur more frequently.

Gout is normally treated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) or with corticosteroids. NSAIDs are taken orally and provide relief by reducing the inflammation associated with the gout. The medicine is usually effective within four hours, and treatments are recommended to be continued for one to two weeks. NSAIDs do not reduce the amount of uric acid in the blood. Many people experience side effects from the use of NSAIDs.

Corticosteroids can be taken orally, or injected into the affected area. This is a very strong anti-inflammatory hormone. Improvement is usually seen within a few hours, and the attack usually subsides completely within a week. These steroids cannot be used if the joint is infected however, as this will be detrimental to the condition.

Without treatment, the repeated attacks can become worse and do some real damage.  Joint surfaces can be deformed or destroyed. Follow-on attacks are not limited to the foot, and may appear in the knee, ear, or hands as well as other parts of the feet. Kidney stones can accompany gout attacks, and kidney problems can commonly occur.  Long term, it is important to lower the level of uric acid in the body, which will eliminate the gout condition.  Several drugs are utilized in this effort, including allopurinol, febuxostat, and probenecid.

Gout of the hand

Gout of the hand

Gout is becoming more common, and affects about 2% of the Western population at some point in their lifetime. Studies are ongoing to learn more about the condition and find better ways to relieve its symptoms and prevent it from occurring.







Photos courtesy:

flickr/Mobiledoc;  flickr/Michael  McCollough