QUESTION
Doctor I think I’m getting old quickly. My foot is swollen and red and is extremely sensitive when I touch it. I have been diagnosed with gout in the same foot before but it has never been so bad. Could there be something else wrong and what can I do for rapid relief?

Two days ago I just woke up with pain – no warning at all. There is diabetes in y family too but I have never been tested. Suddenly I am worried about my blood vessels and don’t want to lose my foot.

It is very uncomfortable and I can barely wear shoes.
I am approaching 68 but I simply cannot accept becoming slower due to this foot. I really love hiking and swimming and my lifestyle is spent mostly outdoors. My wife is also very active and we enjoy ballroom dancing once a week. I am really concerned about the effect of this on our social life.

ANSWER
The condition you describe is certainly no joke – It is notoriously painful, causing sudden attacks of severe discomfort in the joints, usually accompanied by redness and swelling.

    Why does Gout occur?

In simple terms – the uric acid levels in the body become too high.

The result is form of arthritis that can cause great discomfort due to severe pain and inflammation. Crystals can be deposited at different joint services leading to a dramatic inflammatory reaction.

For most people uric acid is cleared from the body by the kidneys, but for reasons that remain unclear, in some individuals it builds up in the bloodstream and forms microscopic crystals around the joints.

So does everyone with high Uric acid levels get gout?

No they don’t. About two-thirds never develop symptoms, and this implies there are other, poorly understood factors at work.

    Who is at Risk?

Obesity and alcohol are major contributors, along with injury to the joints, high blood pressure, eating foods that increase uric acid levels, such as red meat and fish. It has also been shown that the process of fasting can contribute to acid balance changes in the body and so does overeating.

    The most common sites …

Gout can attack more than 1 joint but the most common presentations involve the big toe and the knee.
Pain is usually rapidly progressive and the sensitivity of the joint increases – even a blanket or sheet over joint is unbearable. The agony can be very debilitating and often leads to absenteeism. Duration can be variable and can pain recurrent if not treated properly. Attacks last anything between three and ten days.

Ironically, the pain is caused by the body trying to remove the uric acid crystals from the joints – the resultant inflammatory response.

A specialized white blood cell called a neutrophil zooms in on the crystals to envelope and break them down. The process releases chemical signals, which trigger a host of additional chemical reactions with the resultant mediators of the redness, heat, swelling and PAIN.

How do I treat Gout doc??

Bottom line is – as soon as possible. The response is usually very quick and a complete turnaround if compliant. There are multiple options for anti-inflammatory action a host of medicines to suppress the inflammation.

There are commonly used drugs for this: non-steroid anti-inflammatory drugs (NSAIDs), such as indomethacin, ibuprofen and dicofenac – more recently the cox 2 inhibitors like Celebrex, Arcoxia, Xefo – all with useful effect. The biggest concern with this group of meds is the GIT side effects (gastritis and peptic ulcers) . Colchicine is always advised as acute therapy initiated as per required therapy or until diarrhea develops. Allopurinol is effective as maintenance therapy but not during Acute attacks.

Variable results are achieved with the use of steroids during acute attacks, especially weighing up the use of these drugs in diabetics. Steroids can affect sugar control in higher doses.

An additional caution is the use of NSAIDs in patients on blood thinners like Warfarin. Remember that the working of this drug is potentiated by anti-inflammatories and that just like when consuming cranberry juice and broccoli, the INR blood test should be checked more rigorously. NSAIDs are not suitable for people with a history of liver or kidney disease, and those on blood thinners such as warfarin, because of the tendency to cause bleeding from the stomach lining. .
However, these can also have side-effects such as weight gain and sleep disturbance.

    Prevention of attacks

Maintenance is essential – the long-term use of meds to lower uric acid levels, which work by boosting clearance by the kidneys (a drug called probenecid) or by reducing the formation of uric acid (a medication called allopurinol).

    Complications of Gout

Kidney stones, which are created from a build-up of the uric acid crystals. As a result, kidney damage is common in those with gout, but is also a reflection of other problems such as diabetes or high blood pressure. I urge you to take control of this treatable condition and limit the devastating effects on mobility and quality of life by modifying lifestyle factors not only during acute bouts but long-term.

Doctors treating patients for gout should adopt a prevention better than cure approach too. Change too.

“I have Gout!”, can you Help?
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