GOUT is a rheumatic disease resulting from deposition of uric acid crystals (monosodium urate) in tissues and fluids within the body. This process is caused by an overproduction or under excretion of uric acid. Certain common medications, alcohol, and dietary foods are known to be contributory factors. Acute gout will typically manifest itself as an acutely red, hot, and swollen joint with excruciating pain. These acute gouty flare-ups respond well to treatment with oral anti-inflammatory medicines and may be prevented with medication and diet changes. Recurrent bouts of acute gout can lead to a degenerative form of chronic arthritis called gouty arthritis.
Unlike osteoarthritis or the “wear and tear” arthritis we all suffer, the symptoms of gouty arthritis are different in that it is manifested by an acute onset of severe pain, redness and swelling, many times for no apparent reason. Many patients will complain of a sudden onset of pain occurring early in the morning while asleep. The theory behind this is that when sleeping, the feet are elevated and there is a slight diminishment of blood to the feet which in turn decreases the temperature of the feet just enough for the uric acid to crystallize in the joint of the foot and create pain. Other factors that may precipitate this attack include local trauma, including foot surgery, with an acute medical illness, or following a high purine (protein) diet or alcohol binge.
These attacks most commonly occur in the foot, primarily in the big toe joint. The next most common locations are the middle of the foot followed by the ankle joint. They can also occur at the attachment of tendons such as the Achilles tendon into the heel. It is possible to have these attacks in more than one area at the same time.
Diagnosis is generally on clinical appearance and the presenting history because it is not uncommon for a patient’s uric acid level to be normal during an attack. Colchicine is the drug of choice in acute attacks and is almost diagnostic for gout if the pain is alleviated by the drug. There are other drugs available, primarily the anti-inflammatory class of drugs, but it is important to note that they all do not work in gout. In fact, low doses of aspirin will actually worsen an attack. Consultation with your foot specialist is essential.
The pain generally lasts a few days, and then begins to diminish. The problem is when a person experiences multiple gout attacks over short periods of time. Aside from the pain of the attack, each attack does damage to the affected joint and a person can reach the point where there is so much damage from the repeated attacks, which the joint now becomes constantly painful and surgical intervention is usually necessary.
In those individuals experiencing repeated attacks of gout it is necessary to find out why. Generally speaking, it is usually from either the body overproducing too much uric acid or the kidneys excreting too little uric acid. In either event there is too much uric acid circulating throughout the body. Consultation with specialist is necessary to determine the cause. There is medication available to treat both causes.
Dr Kevin Yip M H
Consultant Orthopaedic Surgeon
Tel: +65 6476 2106