gout, what a pain.

Gout…what a pain in the…

I am often asked this time of year many questions regarding gout.  Such as, what causes it?  How do you treat it?  How it presents, or how do you know its gout. 

Fortunately I learned during my training many years ago, that there are options aside from pumping my patients full of drugs. 

Let’s start; Gout, more specifically acute gout or gout that wakes  you up at night is characterized by burning,redness, throbbing sharp pain that makes you go, “holy crap my foot hurts.”

Sometimes your foot is red and swollen and it feels like the joints in your foot are stiff.

I will attach some pictures of acute gout for you to reference. 

Now let’s discuss causes;  It is well known that the incidence of gout is higher in people with increased dietary intake of purines, (an amino acid, the building blocks for protein) particularly meat and seafood, as well as ingestion of beer and spirits, soft drinks and fructose.¹² It is lower in those with increased intake of coffee, dairy products and vitamin C (all lower uric levels). It must be clarified that coffee and tea can also increase uric acid levels and the presentation of gout. Purine-rich fruits, vegetables and foods include oranges and citrus fruits, cranberries, tomatoes, pineapples, pomegranates, peanuts, beans, lentils, peas, spinach and asparagus. All of the aforementioned foods affect the balance between urate (the main cause for gout) reabsorption and secretion, which is critically linked to the net uric acid (causes gout) elimination in the urine.

One of the best ways I diagnose gout is with a needle aspiration.  This is very fast and simple way to get an accurate diagnosis. The presence of yellow urate crystals, possible moderate amounts of white blood cells and negative cultures is truly the gold standard.

   It is also important to use lab tests to assess the overall state of patient. This includes a complete metabolic panel, urinalysis, blood urea nitrogen, serum creatinine, C-reactive protein and erythrocyte sedimentation rate (ESR). Sometimes, even though there is an acute attack, the uric acid levels may not be above 6.8 mg/dL until two weeks after the attack has subsided. Consider obtaining repeat labs two to four weeks after the initial presentation.

Let’talk about treatment.  First and foremost..diet diet diet, the foods that cause gout, obviously, stop eating those foods and two, see  your doctor for oral meds, but personally, I have found that 6-10cc injection of lidocaine is a great way to dilate blood vessels and flush out the gout crystals, it also offers immediate pain relief.

Keep exercising,

Dr shippee