Dr Dulcy: gout is a pain in the ... toe

MEN ARE MORE LIKELY TO BE AFFECTED THAN WOMEN

The symptoms are sudden burning pain, stiffness and swelling in a joint.

Gout is a type of arthritis that can affect anyone. The usual symptoms are sudden burning pain, stiffness, and swelling in a joint, usually a big toe.

These attacks can happen over and over unless gout is treated. Over time, these attacks can lead to damage to your joints, tendons, and other tissues.

Men are more likely to get gout, but women become increasingly susceptible to gout after menopause.

An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire.

The affected joint is hot, swollen and so tender that even the weight of the sheet on it may seem intolerable. It is a treatable disease and there are ways to make sure it does not recur.

Signs and symptoms

Severe joint pain. Gout usually affects the large joint of your big toe, but it can occur in your feet, ankles, knees, hands and wrists. The pain is likely to be most severe within the first four to 12 hours after it begins.

Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.

Inflammation and redness. The affected joint or joints become swollen, tender, warm and red.

Limited range of motion. Decreased joint mobility may occur as gout progresses.

Causes

With gout, uric acid crystals accumulate in your joint, causing the inflammation and intense pain of a gout attack. Uric acid crystals form when you have high levels of uric acid in your blood.

Your body produces uric acid when it breaks down purines, which are substances that are found naturally in your body, as well as in certain foods, such as steak, organ meats and seafood.

Other foods also promote higher levels of uric acid, such as alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose).

Risk factors

These are factors that increase the uric acid level in your body and they include:

Diet. Eating a diet that’s high in meat and seafood and high in beverages sweetened with fruit sugar (fructose) promotes higher levels of uric acid, which increases your risk of gout. Alcohol consumption, especially of beer, also increases the risk of gout.

Obesity. If you are overweight, your body produces more uric acid and your kidneys have a more difficult time eliminating uric acid, which greatly increases your risk of gout.

Medical conditions. Certain diseases and conditions make it more likely that you’ll develop gout. These include untreated high blood pressure and chronic conditions such as diabetes, metabolic syndrome, and heart and kidney diseases.

Certain medications. The use of thiazide diuretics (amiloretic, ridaq) commonly used to treat hypertension and low-dose aspirin also can increase uric acid levels. So can the use of anti-rejection drugs prescribed for people who have undergone a transplant.

If other members of your family have had gout, you’re more likely to develop the disease.

Age and sex. Gout occurs more often in men, primarily because women tend to have lower uric acid levels.

Complications

People with gout can develop more-severe conditions, such as: Recurrent gout. Some people may experience gout attacks several times each year.

Treatment

Gout medications can be used to treat acute attacks, prevent future attacks and reduce your risk of complications from gout, such as the development of tophi from urate crystal deposits. Drugs to treat acute attacks and prevent future attacks include:

Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include over-the-counter options such as Ibuprofen and Naproxen sodium, as well as more-powerful prescription NSAIDs such as Indomethacin or Celebrex. Your doctor may prescribe a higher dose to stop an acute attack, followed by a lower daily dose to prevent future attacks.