Gout, once known as a ‘disease of kings’ is making a resurgence. With the rise of obesity and a trend of low carb diets such as keto or paleo, the incidence of gout is increasing and its becoming more prevalent in a younger cohort. Gout is an inflammatory arthritis that is a result of excess of uric acid. Hippocrates referred to it as ‘the unwalkable disease’ as the pain can be excruciating. The joint that is most commonly involved is the metatarsophalangeal joint of the great toe, called podagra. Other sites of gout attacks include the ankle, knee, elbow, or wrist. An acute flare of gout may present as a sudden onset of pain during the night and progressively worsen within hours. Often there is swelling and tenderness, the skin overlying may appear red, warm and shiny. Episodes may range from a few days to weeks.
Hyperuricemia, or elevated urate levels can be caused by either decreased excretion, increased production, or increased purine intake. The most common cause of hyperuricemia is decreased renal excretion. Decreased excretion may be a result of genetics, the use diuretics, or renal damage or disease. Increased ingestion of purine-rich foods such as organ meats, anchovies, herring, mussels, sardines, beer, and etc. can lead to hyperuricemia.
Definitive diagnosis usually requires aspiration of fluid from the joint to confirm the presence of urate crystals. Your healthcare provider may also order X-rays to look for erosions or tophi, especially if it is chronic issue. Acute attacks of gout are treated with Colchicine and anti-inflammatory drugs such as NSAIDs. Diet change and decreasing intake of purine rich food or drink may help lessen frequency of attacks. To prevent or decrease recurrence, your doctor may also prescribe Allopurinol to lower the serum urate level or Probenecid to increase the excretion of uric acid. Call your podiatrist today, if you have questions or concerns about gout and the treatment options available.
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