Gout is a form of arthritis, characterized by an acute onset of extreme pain. Gout attacks most commonly occur in the foot and ankle, in particular at the first metatarsophalangeal joint, the joint that connects the great toe to the foot. Gout also appears in the ankle, and can theoretically occur in any joint of the foot.
During an acute attack, the affected joint will appear red and swollen, and it will be hot to touch. It will also be extremely painful to touch. The simple touch of a bed sheet or even a slight breeze can cause an immense amount of pain. Evaluation by a doctor will be used to rule out other possibilities such as a fracture, infection, or other forms of arthritis. X-rays may be taken to visualize the effected joint as well. There are generally not any changes seen on x-ray with the first gout attack, but distinct changes may be seen with repetitive attacks. These changes include bony erosions seen around the joint, with the appearance of bone that has been chewed away. This is referred to as Martel’s sign.
An excess of uric acid in the body causes a gout attack. Uric acid is a byproduct of many foods; in particular it found in high quantity in red meats, lobster, and beer. Because of its association with overindulgence of rich foods, it has been historically referred to as “the disease of kings”. The high volume of uric acid crystallizes at the level of the joints, causing a tophus to form. The crystallization most commonly happens overnight. Some believe that this is due to a drop in body temperature, particularly in the feet, while sleeping.
A high level of uric acid in the body is a condition known as hyperuricemia. The excessive uric acid may come from several different sources. It may be dietary, as in the overconsumption of red meat, beer, and seafood. Hyperuricemia may also be associated with diabetes mellitus, hypertension, psoriasis, or congenital conditions such as Lesch-Nyhan syndrome. Excessive uric acid levels can also be caused by the use of some diuretics, particularly during their early use.
The treatment of gout is twofold; it must address both the acute painful phase as well as controlling the hyperuricemia. Initially, patients may be given colchicine or indomethacin to alleviate pain. After the acute attack has subsided, the underlying hyperuricemia may be addressed with allopurinol a drug that blocks the enzyme that creates uric acid in the body.
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