Causes


  • Genetics: This can lead to either overproduction or under secretion of uric acid. 
  • Diet: Over consumption of purine rich proteins such as in organ meats, red meats, and shellfish. Saturated fats can also decrease the excretion of uric acid. Alcohol leads to dehydration and decreases the body's ability to eliminate uric acid. Fructose (such as in high fructose corn syrup) increases uric acid production. 
  • Injury: This leads to an increase in blood flow to the injured area, increasing the likelihood of uric acid precipitation into a joint. This is especially true of the big toe joint.
  • Medication: Diuretics are known to increase the risk of gout attacks.

Gout is a type of inflammatory arthritis where uric acid precipitates into a joint causing severe pain, swelling, and redness. It is considered the most painful type of inflammatory arthritis known. It is not uncommon to have severe pain with even light touch, such as by a bed sheet or sock. It commonly affects people 30-60 years of age.

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Presentation


  • Extreme pain and redness of the affected joint.
  • ​First symptoms for most people are in the big toe joint.
  • ​It can be self remitting with symptoms improving after a few days.

Gout

Treatment


Acute

  • Oral medication such as Indomethacin, colchicine, or prednisone are used in acute cases.  Pain medication such as narcotics can be used to help manage pain, but has no anti-inflammatory effect.
  • Cortisone injections are extremely effective to reduce both pain and inflammation.


Long Term


  • The primary goal of long term treatment is to reduce serum hyperuricemia and prevent additional gout attacks.
  • Avoid foods that increase uric acid production.
  • Oral medication allopurinol or Uloric are daily medications used to lower uric acid.
  • IV infusion medication is available for patients unresponsive to other medication.