What is Gout?

8 Jan
big toe with gout

Big toe joint inflamed from gout

“I just kind of woke up one morning, stepped out of bed, took one stride toward the bathroom and ended up giving a high falsetto scream, like a six-year-girl, flopping to the floor, [and] grabbing my left big toe.”

That’s how David Wells, legendary pitcher for the New York Yankees and Toronto Blue Jays described his first encounter with Gout. Yes, it will make a grown man cry.

Once thought to be a disease of the upper class, Gout can affect anyone.

It starts with purines

Purines are part of the chemical structure of our genes. They are found in all of your body’s cells and in most foods, but they’re especially high in organ meats, asparagus, mushrooms, herring, dried beans, peas, and anchovies.  As the cells in food are digested, so are the purines, which eventually break down into uric acidic. Uric acid is a key component of our blood and necessary for a properly functioning vascular system.

Normally, uric acid dissolves in the blood, passes through the kidneys, and exits the body via urine. But in some people, uric acid is not discharged correctly, and levels remain too high. Gout occurs when this excess uric acid crystallizes and builds up around the joints, causing inflammation, swelling, and severe pain. It usually first appears in the joint just below the big toe, the same spot where bunions develop. In some cases, small lumps can be seen around the joint, which are actually deposits of uric acid crystals called tophi.

Gout is classified as a form of arthritis, causing pain, swelling, redness, a hot feeling, and stiffness in the affected joint. Besides appearing in the big toe joint, it can also affect your arch, ankle, heel, knee, wrist, fingers, or elbow.

toe joint with gout

How can I avoid gout?

Gout appears more frequently in men than women, but it’s still a bit of a mystery why some people with high uric acid levels (hyperuricemia) develop gout and others don’t. But there are certain factors that science recognizes as contributing factors:

  • genetic predisposition – an enzyme defect which makes it difficult for your body to break down purines
  • being obese or overweight
  • a diet high in alcohol consumption, especially beer
  • a diet high in purine-rich foods
  • extremely low calorie diets
  • rapid weight loss
  • overuse of aspirin
  • overuse of the vitamin niacin
  • chronic kidney disease
  • long term use of diuretic medicines
  • medicines taken by transplant patients
  • high blood pressure
  • psoriasis
  • tumors
  • surgery
  • myeloma
  • hemolytic anemia
  • lead poisoning
  • hypothyroidism
Symptoms of Gout
  • Severe pain –  and a hot feeling in the affected joints, accompanied by redness and inflammation, most commonly first appearing in the big toe (podagra)
  • Red skin – the area around the joint may become red or purple, appearing similar to an infection
  • Fever
  • Stiffness in the joint
  • Pain may subside – an untreated gout attack can last for a week or more, and then fade
  • Itchy skin – as the gout subsides, the skin around the joint may start to itch and peel away (peeling skin is one of the ways your body sheds the extra uric acid)
  • Small lumps (tophi) – appearing around the elbows, hands, or ears

Some patients experience no symptoms, which unfortunately may develop into chronic gout.

Gout symptoms come on very suddenly, and many times during sleep, as in David Wells’ story. If you experience sudden and intense pain in your big toe, or anywhere else in your foot or ankle, make an appointment with your podiatrist immediately for a thorough evaluation. If you leave gout untreated, it may become much worse.

For more information on gout, see the National Institutes of Health page

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