This week we loaded a video about a gentleman with a gout attack. People are asking, “what is gout?” According to the Mayo Clinic, ‘Gout is a common and complex form of arthritis that can affect anyone’. It’s characterized by sudden, severe attacks of pain, swelling, redness and tenderness in the joints, often the joint at the base of the big toe.
Gout occurs when our bodies either manufacture too much of a chemical called Uric Acid, or our kidneys do not eliminate enough. In both cases, uric acid levels will build up in the blood, and when it circulates, and reaches the parts of our bodies that are cooler than our core, it will cool into crystals. When these crystals end up in a joint space, it is described as sharp pins or razor blades cutting into the joint. It is extremely painful.
The big toe joint is the most common joint affected, which is why these patients come into my office. But a gout attack can actually affect any joint in the body. The attack usually comes on quite suddenly, and patients will tell me the exact minute that the pain woke them up in the middle of the night. The joint is hot, red and swollen. The patient cannot move the joint, or touch the joint, and it almost hurts just to look at it!
HOW FOODS AFFECT GOUT
When we eat food, the enzymes in our bodies break that food down to molecules that our bodies can absorb. Certain foods have uric acid as one of those breakdown products. These can trigger gout. The Arthritis Foundation has a list of foods to avoid. Once a patient is diagnosed with gout, there are medications that can be used to help our kidneys excrete more uric acid. But patients are also encouraged to work with a nutritionist to help develop a good diet that avoids these foods.
A couple of the foods that can trigger a gout attack are red meat, and any organ meats, such as liver or kidney. In the middle ages, most people could not afford such meats, which is why this disease is attributed to the wealthy class.
OUR PATIENT IN THE VIDEO
In this video, you saw x-rays that showed destruction of the joint. If the uric acid crystals are in the joint too long, as with a low-grade chronic gout situation, joint destruction is almost guaranteed. There are very specific patterns of joint destruction that can be seen with gout.
Lastly, one viewer commented that they had never seen gout drawn out of a joint like this. This patient is an exception. The large mass over his joint was fluctuant, a big word meaning “mushy”, so I knew it was filled with fluid. Usually I do not aspirate fluid from a gouty joint, as it is just too painful.