What is a gout?

 

A swollen, red joint in the big toe is considered a hallmark sign of gout?

True or False

Dr.’s RESPONSE:  This is absolutely true.  In fact, it even has its own name: podagra.  Gout is a recurrent acute arthritis that affects peripheral joints, most notably the big toe joint.  The condition is due to a build up of monosodium urate crystals in and around joints and tendons. Highly saturated body fluids condense and then crystallize.  These crystals cause severe pain in the affected joints.  It’s almost as if there a tiny needles in the joints.  With each movement, those small needles scrape against the tissues, causing severe pain.  Acute gouty pain is unmistakable.  Patients often describe it as though they cannot even bear to have bed sheets touch their foot.  Another common complaint is that the air conditioner blowing on the affected foot is extremely painful.  Other symptoms include sudden onset of single joint pain, low grade fever, 20:1 male to female ratio, crunchy tophi formation, and a red hot swollen big toe joint. 

Acute gout may become chronic and deforming.  Chronic gout causes destruction of the joint edges and actually erodes away portions of bone.  It can also lead to the accumulation of gouty tophi, a substance created by the body that resembles shards of glass mixed with cottage cheese.  These accumulations can develop in the feet, hands, on the elbows, knees, ears, and even the tip of the nose.  

Gout classically begins in the morning or early evening and tends to occur in previously damaged joints.  The well accepted theory is that gout crystals have an aversion to warm parts of the body.  But they also need a large enough area to accumulate.  Therefore, the big toe joint, far away from the main heat source of the body and yet large enough to allow urate crystal deposition to occur is the ideal location for these crystals to condense.  Many factors contribute to the formation of these crystals, with diet being a major contributor. Avoid organ meat, lard, sardines, alcohol (especially red wine), diuretics, and certain medications. 

There are basically two kinds of gout which are the “under-excretors” and the “over-producers.”  Under-excretors are those individuals that can not clear enough of the crystals from the blood stream via their kidneys.  This is the more common type of gout and it is also known as renal gout.  The other, less common type is known as metabolic gout.  This is due to a defect in genetic enzymes.  Both are treated with medications and lifestyle changes.

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.flfootandankle.com