Gout

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What is gout?

Gout is a complex disease that affects the joints. A form of arthritis, it can be very painful. The joint at the base of the big toe is often the one most affected, but the ankle joint may be affected as well. Left untreated it can lead to painful foot deformity, arthritis and even kidney problems. The foot and ankle physicians at Midwest Orthopaedics at Rush say that when gout is treated early, it can prevent future problems.

What are the symptoms of gout?

Gout can cause sudden and extreme joint pain, redness, tenderness, and swelling. Sufferers may experience a burning sensation and the joint may feel hot to the touch.

Who is likely to get gout?

Gout can affect both men and women. Men are more prone to gout, but women's susceptibility increases after menopause. A patient is also more at risk of gout if family members have had it or if the patient has high levels of uric acid in his body.

What are the causes of gout?

Gout is caused by the build up of urate crystals in the joint. Urate crystals occur when a patient has elevated levels of uric acid in his blood. Uric acid is formed when the body breaks down purines - naturally occurring bodily substances also found in foods, such as anchovies, herring, organ meats, mushrooms and asparagus.

Usually, uric acid passes through the kidneys into the urine, but sometimes the body either overproduces uric acid or the kidneys do not excrete enough. As a result, uric acid accumulates, creating needle-like crystals in the joint or nearby tissue that cause pain, tenderness and swelling.

Some factors that can raise a patient's uric acid levels include:

  • Excessive alcohol intake
  • Untreated hypertension (high blood pressure), diabetes, hyperlipidemia (high amounts of fat and cholesterol in the blood) and arteriosclerosis (thinning of the arteries)
  • Thiazide diuretic use (common treatment for hypertension), low-dose aspirin and anti-rejection drugs (prescribed to organ transplant patients)
  • Genetics

How is gout diagnosed?

The foot and ankle surgeons at Midwest Orthopaedics at Rush may conduct a joint fluid test and/or a blood test to help diagnose gout. A joint fluid test consists of drawing fluid from the affected joint and examining the sample under a microscope to reveal the presence of urate crystals. A blood test measures the blood's uric acid level, but this exam can be misleading. Some patients suffering from symptoms of gout may not have high levels of uric acid in their blood, and in other cases, people with elevated uric acid levels never experience gout.

What are the treatments for gout?

At Midwest Orthopaedics at Rush, foot and ankle specialists will prescribe gout medications based on the patient's health and personal preferences. These medications will treat and prevent sudden gout attacks and reduce the patient's susceptibility to complications from gout. Such medications include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs, such as Advil, Aleve or Motrin) to reduce the inflammation and pain, stop a sudden attack, or prevent a future one
  • Colchicine to relieve the pain
  • Corticosteroids to control swelling and pain – often only prescribed if the two medications above are not compatible with the patient. Side effects can be thinning bones, decreased ability to combat infection and poor wound healing.
  • Xanthine oxidase inhibitors (such as Aloprim, Lopurin, Zyloprim and Uloric) to block or limit the production of uric acid; however, these medications may trigger another sudden attack if taken before the last attack has fully resolved.
  • Probenecid to heighten the kidneys' ability to remove uric acid from the body

If gout goes untreated, urate crystals can continue to accumulate in the patient's urinary tract, causing painful kidney stones, or they can collect to form urate deposits called tophi under the skin. Normally, tophi are not painful, but they can become inflamed and tender during a gout attack. Tophi can form on fingers, hands, elbows, feet or Achilles' tendons. The foot and ankle specialists at MOR may recommend surgery to remove the tophi.