Gout is a painful inflammatory condition caused by an increase in uric acid levels that result in the deposit of monosodium urate crystals in specific joints of the body. Uric acid is formed when purines (molecules containing nitrogen) are metabolized (broken down), which then combine with sodium in the body to form urate crystals. When urate levels in the blood reach 6.8 mg/dL there is a greater likelihood of the crystals forming and depositing in specific joints, causing pain, swelling, inflammation, and redness. If left untreated over time, these crystals can form larger lumps called tophi, which can lead to damage of the joint. Symptoms of gout include rapid onset of pain, usually during the night, with pain reaching its maximum within 6 to 12 hours of onset. Typically gout affects the big toe at the metatarsophalangeal joint, however, joints of the foot, ankle, knee, hand, and wrist can also be affected. Initial episodes of gout can be separated by years, but if left untreated episodes may become more frequent.
Gout typically occurs in men more than women, with the average onset being between the ages of 40 and 60. Medical conditions such as obesity, high blood pressure, diabetes, and reduced kidney function are associated with the onset of gout. In addition, medications such as diuretics, anti-hypertensives, and lipid lowering drugs can affect kidney function, and therefore alter the mechanism in which uric acid is broken down.
Diet can also play a role in the onset of gout. Research has shown that foods rich in purines are associated with increases in uric acid levels in the blood. Examples of purine-rich foods include: beef, pork, lamb, veal, organ meats (i.e. liver, heart), tuna, halibut, herring, sardines, shrimp, lobster, scallops, beer, wine, asparagus, cauliflower, beans, lentils, and spinach. Interestingly, consumption of cherries has been linked to lower uric acid levels.
The diagnostic gold standard for gout is joint aspiration, where a needle is inserted into the affected joint to draw out synovial fluid. The fluid is then analyzed for the presence of urate crystals. In addition, blood tests can also be performed to determine the levels of uric acid in the blood, however, elevated levels of uric acid can exist without the presence of any symptoms. Diagnostic imaging, such as CT, MRI, and ultrasound can also be used to determine the if tophi are present in chronic cases of gout.
Your doctor may prescribe certain medications that can help to reduce uric acid levels and inflammation. Certain NSAIDs (nonsteroidal anti-inflammatory drugs) are often prescribed at the onset of the symptoms, however, other medications that also help to reduce uric acid levels and inflammation may also be prescribed. Please consult with your physician to determine which medication(s) would be most effective for your condition. In terms of non-pharmacological treatment, rest, ice, and elevation are often helpful in reducing your symptoms. Your physiotherapist may also use modalities such as ultrasound or laser in the acute phase. Range of motion, strengthening, and/or stretching exercises of the affected joint can be performed between flare ups to maintain function. If your ability to walk is compromised due to pain, your physiotherapist may also recommend a gait aid, such as a cane, to prevent you from developing poor gait patterns. Please consult with your doctor and physiotherapist to determine the best treatment plan for you.
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