Are you suffering from severe attacks of pain, swelling, redness, and tenderness in the joints – especially in the base of the big toe? Do you wake up in the middle of the night with the sensation your big toe is on fire?
If you do, it could be gout, a common form of inflammatory arthritis that can be very painful. It usually affects one joint at a time, fifty percent of the time in the big toe joint. Gout was known as a “rich people disease,” since only the wealthy could afford to eat a rich diet of food that could lead to gout, said Erdal Diri, MD, a rheumatologist with Trinity Health. “Now, everyone gets it.”
According to the Arthritis Foundation, 4 percent of American adults – about 6 million men and 2 million women – have gout. And the rates of gout are increasing, Dr. Diri pointed out, calling it “a culture-related disease” and crediting it to the quality of diet, obesity, and hypertension.
While he attended medical school, Dr. Diri said he did not see cases of gout in patients until they were in their forties and above; now, he said, they are in their twenties, and sometimes in their teens.
The signs and symptoms of gout almost always occur suddenly and often at night, Mayo Clinic said. Those signs and symptoms include:
- Intense joint pain. Gout usually affects the large joint of your big toe, but it can occur in any joint. Other commonly affected joints include the ankles, knees, elbows, wrists, and fingers. The pain is likely to be more 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. As gout progresses, you may not be able to move your joints normally. Gout is caused when there is a presence of hyperuricemia, or an excess of uric acid in the body, which causes uric acid to form needle-like crystals in a joint.
Uric acid is a substance that normally forms when the body breaks down purines, which are found in human cells and in many foods. It is then transported by the blood to the kidneys and eliminated in the urine. However, some people either overproduce uric acid or they produce a normal amount, but their kidneys can’t process it efficiently, leading to an excess of uric acid. Some, but not all, of these people develop gout.
There are times when symptoms flare (get worse) or go into remission (when there are no symptoms). Repeated bouts of gout can lead to gouty arthritis, a worsening form of arthritis.
If symptoms of gout persist, Dr. Diri suggests seeing your primary care provider. There, the provider will rule out other potential causes of joint pain and inflammation, such as infection, injury, or another type of arthritis. “Gout is not curable, but it is treatable,” he said.
It can be effectively treated and managed with medication and self-management strategies. Gout can be treated by an anti-inflammatory medication to get it under control, Dr. Diri said. Then, through medications, the production of uric acid can be reduced. This can be done with Allopurinol, which is used to treat high uric acid in the blood of patients with gout by reducing the amount of uric acid.
There are also instances, outside of genetics, that can be risk factors for gout. According to the Arthritis Foundation, those risk factors include:
- Genes. If family members have gout, you’re more likely to develop it.
- Other health conditions. High cholesterol, high blood pressure, diabetes, and heart disease may raise your risk.
- Medications. Diuretic medications, or “water pills” taken for high blood pressure, can raise uric acid levels; some drugs can suppress the immune system taken by rheumatoid arthritis and psoriasis patients, as well as transplant recipients.
- Gender and age. Gout is more common in men than women until around age 60. Experts believe natural estrogen protects women up to that point.
- Diet. Eating red meat and shellfish increases your risk. (Foods with high levels of purine include alcoholic beverages; some fish, seafood, and shellfish, including anchovies, sardines, herring, mussels, codfish, scallops, trout, and haddock; and some meats, such as bacon, turkey, veal, venison, and organ meats like liver.)
- Alcohol. For most people, more than two liquor drinks or two beers a day can increase the risk of gout.
- Sodas. The fructose in sweet sodas has recently been shown to increase gout risk.
- Obesity. Obese people are at a higher risk for gout, and they tend to develop it at a younger age than people of normal weight.
- Bypass surgery. Those who have undergone gastric bypass surgery also have an increased risk.
To help prevent gout (outside of genetics), Dr. Diri recommends that a person watches their diet and exercises. If you believe you have gout, please call your primary healthcare provider.