When my patients come in to see
me saying they have a 10/10 pain of their great toe and cannot even let their
bed sheet touch their foot, I automatically think of gout.
Usually the pain has come on overnight with no history of injury. The pain of an acute gouty attack can be
excruciating and may be triggered even by light touch or movement. The
pain can be so severe that some people even resort to emergency room treatment
for pain relief. Gout is caused by having increased levels of uric acid
in your blood and then having the body react to these increased levels
meanwhile causing pain and inflammation.
Most of the time the increase in uric acid levels is caused by something
they have eaten.
What is happening?Uric acid is a product of the break down of purines in your body. Your body not only produces purines but you can store larger amounts of uric acid secondary to a protein rich diet. Too much of anything can be bad for you and this is very true with uric acid. Your body thinks of the excess uric acid as an unwanted house guest and attempts to get rid of it by sending your immune cells to make it go away. The immune response causes pain, swelling, warmth, and redness that typically accompanies an acute gouty attack. The attacks can last between 3-5 days and prompt treatment will decrease symptoms fairly quickly.
The most common person to have a
gout attack is a male between the ages of 30-45. Women usually have
attacks starting post menopause, between the ages of 55 and 70 years of
age. If you have a family history of gout your chances increase as
well. Other medical conditions such as kidney disease, high blood
pressure, and diabetes can also contribute to the prevalence of gout.
Medications such as diuretics (water pills) and also aspirin have shown they
may increase uric acid levels. Finally, being overweight and consuming large
amounts of alcohol can contribute to the cause of a gouty attack. Certain foods that are good for you may still
cause an increase in your uric acid level.
What should I do?
So what can you do if you have a
red, hot, swollen, and tender foot? You can easily try some simple home
remedies such as applying ice to the affected area, elevating the limb, resting
the limb, and using over the counter non-steroidal anti-inflammatory drugs
(NSAID) such as naproxen or ibuprofen if okay with your doctor. Essentially
what you are trying to do is decrease that inflammatory response the body has
when encountering high levels of uric acid. You are trying to prevent the
swelling and warmth by counteracting it with anti-inflammatory methods.
This is very effective and some people require no further treatment.
If by chance your pain persists
your doctor may prescribe you a stronger NSAID, such as colchicine or
indomethacin, or a steroid to calm the inflammation down. Doctors could
also inject a local anti-inflammatory into the affected area and this would
also decrease pain and swelling dramatically.
After the acute attack and
everything starts to calm down, you may have to repeat a blood test to make
sure your baseline uric acid levels are normal. If they are elevated when
no attack is happening then your doctor may consider placing you on a
maintenance medication, such as allopurinol or probenecid, so as to prevent
future flare ups. You may also try to lose weight, drink lots of water,
and avoid large consumption of alcohol and meats. There are lists of certain foods that can
increase and decrease the levels of uric acid.
If gout is something you may have problems with, schedule an appointment with us today.
