Gout is an abnormal accumulation of uric acid in the blood stream according to Dr Marc Blatstein. This results in crystals being deposited in joints which in turn elicit pain. While the big toe joint (classically) is mainly affected, symptoms can also result in the knee (Pseudo Gout) with other joints also being affected. Physically, there is associated swelling, redness and increased warmth, with the chief complaint being; that “it even hurts when my bedroom sheets touch my feet”.
Blood tests (and/or possibly a Urine analysis) taken during an attack of gout may or may not demonstrate an abnormal uric acid level. According to Dr Marc Blatstein, a good clinical exam with history is very helpful in a diagnosis of Gout, and at times is all that is necessary. While the Gold Standard is aspirating the involved joint to so that it can be evaluated for crystals, this is a very painful procedure.
An attack of gout can resemble an infection, and if left untreated for years can actually cause boney destruction. When left untreated, the damage to the bone is so severe that when evaluated surgically, has changed the bone to a consistency soft, similar to cottage cheese- demonstrating its bone destruction.
Treatment often consists of medications: Indocin (an NSAID) for inflammation, colchicine to stabilize the cell wall of the WBC & allopurinol to inhibit the further release of crystals into the joint. In extreme cases, non weight bearing with the use of crutches is useful. Once proper medication is prescribed, the symptoms of gout will usually start to subside quite rapidly.
Factors that contribute to the onset of gout are alcohol, red meats just to mention a few (a change in diet is usually recommended), aspirin and certain medications. Patients who may have kidney damage from diabetes or other causes, and due to their diseases
can also develop gout. These patients may exhibit atypical forms of gout.