Question: A friend of mine complains about his "big toe disease" or gout. I thought this was some old-fashioned disease or a made up thing. Is this a real condition? If so, what is gout and what causes it?
Answer: Gout is a painful type of arthritis. References to gout have been recorded as far back as ancient Egypt. It has been called "the rich man's disease" especially during the depression, because it was thought to be caused by a "rich" diet, heavy in meat.
We all have a chemical, uric acid, in our blood as a byproduct of normal metabolism.
Uric acid is eliminated in our urine, and some people cannot eliminate as well as others. Too much remains in the blood and, in some of these people, the uric acid will form sharp crystals which deposit in the joints.
The most common joint is between the foot and big toe, which is called podagra. With these crystals now in the joint, the body quickly reacts, and the joint will become swollen, red and very painful.
The diagnosis of gout is usually clinical, based on the history and examination. Fluid from the joint may be obtained to look for uric acid crystals to confirm the diagnosis. Lab tests to check the uric acid level in the blood will be needed. I would compare the gout attack to opening a joint and pouring in ground-up glass. Ouch! Gout attacks can be frequent or years apart.
Risk factors for gout include obesity, diabetes, hypertension and renal failure. Diet also plays a role. Alcohol, meat and seafood can increase the frequency of attacks in gout patients. A family history of gout will increase your risk.
Treatment is divided into two parts: acute attack medication and prevention.
For an acute attack, these types of medication can be used: cortisone products (tablets or injection) and anti-inflammatory medications such as indomethacin and colchicine. Usually, some improvement will be seen in the first twenty-four hours.
If you have frequent attacks, prevention is a must. Uncontrolled gout can lead to joint damage. Controlling the risk factors, including watching your diet and alcohol consumption, better diabetes control, and weight loss, may help decrease the number of attacks.
Some evidence suggests eating cherries or cherry elixir can help. Unfortunately, some people will need medication to lower the uric acid levels. Allopurinol is a common type of medicine used to decrease acute attacks and longterm joint damage.
So, if you wake up one morning after a great night out at the seafood buffet and brewery with a red, swollen, and painful big toe and foot, gout would be a good consideration.
Your primary care doctor can usually handle this problem, but in severe cases, a consult with a rheumatologist may be needed.
Follow reporter Mindy Lucas on Twitter at twitter.com/MindyatIPBG.
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