April 15--It's a lousy way to wake up -- with intense pain and redness around your big toe or other joints.
No doubt about it: Gout stinks -- and it's becoming more common -- but it's also quite treatable.
Gout, a crystal-induced arthritis, is caused by the buildup of a natural waste product, uric acid, in the joints. The big toe is a common starting point, but it also can occur in the ankle, heel, knee, wrist and finger areas. An attack usually occurs at night because the body is cooler and that allows uric acid crystals to form.
"People don't even want a bedsheet on the toe, it's so painful," said Dr. Kasey McCreigh, a physician with Parkview Family Medicine. "They're pretty miserable. The first eight to 12 hours are when it's really intense."
Uric acid is created as the body breaks down purines -- natural substances that are found in most foods. The formation of the crystals occurs when the body is overproducing or underexcreting the acid.
Gout affects about 3 million people and men are more prone to experience it. A diet of foods high in purines can be a significant contributor to a gout attack.
"Organ meats are higher in purines," said McCreigh. "Sweetbreads (thymus and pancreas) are real bad. High-fructose corn syrup, beer and hard liquor are high.
"(When a patient comes in) with gout, they tend to be eating things that are rich in purines."
Even some healthy foods -- spinach, mushrooms and some fish -- are high in purines.
Diagnosis is critical because even though gout is common, there may be another condition causing the acid buildup. A condition called pseudogout causes similar symptoms but is the result of calcium pyrophosphate crystals, not uric acid. It requires a different type of treatment.
The most accurate diagnosis is one that anybody in the midst of a gout attack won't want to hear.
"The best way is to tap the joint and look at the fluid, but it's hard to convince patients to (let you) stick a needle in there when they have a really sore toe," McCreigh said. "Getting a uric acid level with blood work is probably the most misused (diagnostic), but it's the easiest one."
It's important to make sure a patient doesn't have a fever or other symptoms that could indicate an infection is the cause of the problem, he said, and 24hour urine collection can offer even more definitive clues.
"You can have a normal UA level and still have gout. You can have a high UA and not have gout," said McCreigh.
Treated with NSAIDs
The most common treatment for gout is nonsteroidal antiinflammatory drugs. In some cases, a corticosteroid may be given.
Gout cases have increased as our life spans and waist sizes have done the same, McCreigh said. Hypertension, obesity and diabetes increase the likelihood of a gout attack (and some hypertension medications can increase uric acid levels). Therefore, the primary preventive treatments are weight loss and a diet that minimizes foods that are high in purines.
"Keep your blood pressure down and be informed about what you're eating," said Mc-Creigh.
A gout attack typically lasts a couple of weeks if untreated. Treatment usually results in big improvements within a few days. Many people won't experience another bout.
"The biggest thing is that it's pretty treatable and even when common treatments fail, there are newer therapies to manage it," said McCreigh.
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