Gout is an abnormal accumulation of uric acid crystals in the blood stream according to Dr. Marc Blatstein, which results in these crystals being deposited in joints which in turn elicit pain. While the big toe joint (classically) is mainly affected, symptoms can also result in the knee (Pseudo Gout) with other joints also being affected. Physically, there are associated swelling, redness, increased warmth, with the patients main chief complaint being; “Doc, it even hurts when my bedroom sheets touch my feet”.
A diagnostic tool, blood tests (and/or possibly a Urine analysis) are often taken during an attack of gout, but these tests may or may not be positive for an increased uric acid level. According to Dr. Marc Blatstein, a good clinical exam with history is very helpful in the eventual diagnosis of Gout. The Gold Standard involves aspirating the involved joint to evaluate the joint fluid for crystals, but Dr. Blatstein cautions that this is a very painful procedure. An attack of gout can resemble an infection where it will be treated as such but if left untreated for years it can actually cause boney destruction. It has been the experience of Dr. Marc Blatstein, when left untreated the damage to the bone and joint is such that the bone is seen to have disintegrated to a consistency resembling that of cottage cheese. With the advances in medicine and pharmaceuticals, there is no reason that this should occur any more, as long as you and your physician work as a team.
Treatment often consists of medications: Indocin (an NSAID) for inflammation, colchicine to stabilize the cell wall of the WBC & allopurinol to inhibit the further release of crystals into the joint. In extreme cases non weight bearing with the use of crutches is useful. Once proper medication is prescribed the symptoms of gout will usually start to subside quite rapidly.
Some of the factors that contribute to the onset of gout are alcohol, red meats just to mention a few (a change in diet is usually recommended), aspirin and certain medications. Patients who may have kidney damage from diabetes or other causes, and due to their diseases can also develop gout. These patients may exhibit atypical forms of the disease.
For a greater understanding on Gout, Dr. Marc Blatstein recommends taking advantage of this link: U.S. National Library of Medicine – The World’s Largest Medical Library Dr. Marc Blatstein, Gout