Gout is a type of arthritis that affects millions of Americans. It is the most common crystal-induced arthropathy. It is now estimated that 4% of the US population now suffers from gout. Gout cases increase each year with the increase in national obesity, high cholesterol, diabetes and heart disease.
Symptoms: Our bodies normally make a chemical called uric acid. When too much of this chemical is produced it can lead to build of crystals in certain joints. The typical symptoms of gout are red, hot, swollen joints in the big toe, ankle, wrist, finger and knee. Attacks can begin quickly after an acute or a repeated use injury, ingestion of liquids or food that has high levels of purines. Tophi is a collection of urate crystals in soft tissue, which presents like a white creamy discharge that can sometimes be seen in joints of patients with gout.
Diagnosis: Gout is typically seen as a red, hot swollen joint upon physical examination. The big toe joint is the most common place to see gout in the foot. Diagnosis can also be made with an X-ray, where arthritic changes can be seen at the joint. Lesions on an X-ray can sometimes resemble a “rat bite” type appearance. Blood work can be done to see serum uric acid levels, which typically should be less than 6 mg/dL. Tophi expressed from the joint can also be examined under a microscope which will show a very specific negatively birefringent urate crystals.
Treatment: Gout is usually treated acutely and chronically. The acute attack can be treated with oral medications, cortisone injections and/or immobilization of the affected joint using a rigid shoe. Depending on the severity of the attack, long term medication may also be needed to keep reduced uric acid levels.
Prevention: Sometimes gout attacks cannot be prevented, such as instances with acute trauma. However majority of gout cases can be prevented with proper diet and exercises. Reducing food consumption with high level of purines such as red meats and certain seafood and reducing ingestion of excessive alcohol reduces the risk of gout attacks and prevents uric acid buildup.
“Gout and Pseudogout.” Practice Essentials, Background, Pathophysiology, 12 Apr. 2019, emedicine.medscape.com/article/329958-overview.
“Gout and Pseudogout Workup: Approach Considerations, Synovial Fluid Analysis, Serum Uric Acid.” Gout and Pseudogout Workup: Approach Considerations, Synovial Fluid Analysis, Serum Uric Acid, 12 Apr. 2019, emedicine.medscape.com/article/329958-workup#c12.
“Gout Diet.” DietDiet.com, 30 Mar. 2016, www.dietdiet.com/gout-diet/
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