Something about gout

Gout is an inflammation within a joint caused by the buildup of uric acid.  It is often thought of as an “old man’s” disease.  In reality, it affects about 2 percent of men over age 30 and women over age 50.  

When we eat, the digestive system breaks down food into its most basic components.  The body then uses the nutrients immediately for energy, stores them for later use, or uses them to make other essential building blocks.  

One of these basic substances is purines.  Purines are key components in the production of nuclear material (DNA).  When purines are metabolized they produce uric acid.  Normally, uric acid dissolves in the blood stream and eventually is eliminated through the kidneys.  However, some individuals will make too much uric acid for the kidneys to handle.  Others just can’t eliminate it effectively.

Uric acid in the bloodstream can make its way into the joint fluids.  Here it crystallizes, causing inflammation and pain, or gouty arthritis.  Any joint in the body can be affected, but gout is most commonly seen in the lower extremities, particularly the big toe.  

An individual suffering from an acute gouty arthritis will experience pain, swelling, redness and heat in the affected joint.  The attack is usually sudden in onset and often occurs overnight.  The area is so sensitive that many will describe excruciating pain in the toe with just the weight of the bed sheet on it.            

Chronic inflammatory arthritis from gout can lead to permanent disfiguring of the joint as the uric acid crystals build up over time in the joint space.  Some will develop “tophi,” nodules over the joint where the crystals collect.  Eventually, the inflammation can lead to destruction of the bones in the joint.  Other complications include uric acid kidney stones and kidney damage.

Treatment of an acute gout attack is aimed at reducing the inflammation caused by the crystal deposits.  This alleviates the swelling and pain in the joint.  Anti-inflammatory medications (e.g. ibuprofen, naproxen, and indomethacin), heat and/or ice packs, and resting the affected joint are the most commonly prescribed strategies.   Other medicines can be used to prevent crystal formation or to help eliminate uric acid from the body.  Individuals who have chronically high levels of uric acid in the bloodstream can benefit from daily doses of these medicines.

There are many identified risks to developing gout.  Men are more likely to get gout than women.  Women are more likely to develop gout after menopause.  Overweight and high cholesterol can predispose individuals to developing gout.  Also, certain medications such as diuretics or “fluid pills” can precipitate the disease.

Alcohol consumption is also a risk factor.  Foods that are rich in purines may precipitate it as well.  Foods that have the highest concentration of purines are red meats and certain seafood.  The highest purine levels are present in liver, anchovies, sardines, salmon, herring, mussels, bacon, codfish, scallops, haddock, veal and venison.  Consumption of dairy products may decrease gout attacks.

The content in this column is for informational purposes only.  Consult your physician for appropriate individual treatment.  Dr. Reynolds practices Family Medicine in Chesterfield.

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