What Is Gout Its Causes
Gout is actually a type is arthritis that happens due to hyperuricemia, a condition where blood uric acid level increases more the normal level. So, what happens when uric acid increases in our body?
Uric acid present in the blood gets ionized into Monosodium Urate Crystal. Normally these urate crystal gets dissolved and its solubility is affected by:
- Synovial fluid pH,
- Electrolytes level, and
- Other synovial components such as proteoglycans and collagen.
But, when the level of uric acid increases the urate crystal starts deposition gets starts in the tissue around the joints leading to gout. There are two factors that causes the increase in the uric acid level one is overproduction of uric acid and second condition is when there is decreased excretion of uric acid from the body.
The Role Of Physical Activity In Prevention Of Gout
Along with diet, physical activity can help with weight loss, and gout has been associated with being overweight.7 in patients with well-established gout, especially if X-rays have demonstrated joint damage in the foot, a low-impact exercise program is reasonable. An exercise program combined with diet in gout can reduce risk for attacks.7 If an attack seems to be coming on in the lower extremity, patients are well-advised to try to get off their feet, since impact seems to worsen gout attacks. Clues to an attack of gout coming on include local swelling, heat, redness, and tenderness in a joint, especially in the foot, ankle, or knee. Some patients have fever and chills as the first warning that an attack of gout is coming on.
What Causes Gout Pain
Picture a collection of glass shards pressing outward like needles. This is what it can feel like during a gout flare, when a buildup of uric acid in the blood forms microscopic crystals that grow in and around a joint. As the build-up increases, the immune system responds to these crystals, causing inflammation that leads to visible swelling, redness, and debilitating pain.
In some cases, a gout flare can even lead to a fever and look like an infected joint, Dr. FitzGerald notes. The treating doctor may need to look for possible source of infection, often by removing fluid from the joint to send to the lab to look for crystals or bacteria.
Uric acid is a byproduct of the body breaking down proteins called purines from your own cells and from certain foods such as red meat and shellfish. Alcohol and drinks sweetened with high fructose corn syrup are also high in purines. Normally, uric acid dissolves in your blood and is filtered out through your kidneys, but when your body produces too much uric acid or your kidneys fail to filter it, either due to familial causes or kidney disease, then the uric acid builds up and creates the needle-like urate crystals that cause gout and can also form kidney stones, according to the Mayo Clinic.
Certain factors make some people more likely to develop gout, according to the U.S. Centers for Disease Control and Prevention. Gout risk factors include:
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How Is Gout Diagnosed
In a clear-cut case, a primary care physician can make the diagnosis of gout with a high level of confidence. However, often there are two or more possible causes for an inflamed toe or other joint, which mimics some of the symptoms of gout, so tests to identify the presence of uric acid is performed.
Since the treatment for gout is lifelong, its very important to make a definitive diagnosis. Ideally, the diagnosis is made by identifying uric acid crystals in joint fluid or in a mass of uric acid . These can be seen by putting a drop of fluid on a slide and examining it using a polarizing microscope, which takes advantage of the way uric acid crystals bend light. A non-rheumatologist, when possible, can remove fluid from the joint by aspirating it with a small needle and send it to a lab for analysis. A rheumatologist is likely to have a polarizing attachment on their microscope at their office. Gout crystals have a needle-like shape, and are either yellow or blue, depending on how they are arranged on the slide .
Figure 11: Uric Acid Crystals Under Polarizing Light Microscopy
There are many circumstances where, however ideal it would be, no fluid or other specimen is available to examine, but a diagnosis of gout needs to be made. A set of criteria has been established to help make the diagnosis of gout in this setting .2
Table 1: Diagnosing gout when no crystal identification is possible
Ideally, 6 of 10 features will be present of the following:
How Do I Prevent Gout
Preventing gout means addressing the cause of your uric acid build-up as well as any personal risk factors identified by your healthcare team. This means investigating any metabolic disorders and kidney function, as well as promoting lifestyle measures like diet and exercise. Your doctor may also put you on urate-lowering therapy, which looks to medically manage your urate levels to help reduce the likelihood of a flare.
Here at My FootDr, we help our patients by providing them with the right tools and support to maximise their comfort for when their flares do arise. Many of our patients must still continue to work during their flare, and when your occupation involves being on your feet , having some offloading to give you relief by redistributing the pressure away from the big toe and to the lesser toes can make a big difference to your quality of life and ability to work.
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What Are Symptoms Of Gout In Your Foot
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The Different Types Of Gout
Primary gout is due to an innate hereditary problem that results in the buildup of uric acid within the body. 90 percent of people who are diagnosed with primary gout are male the condition is virtually nonexistent in premenopausal women.
Secondary gout develops as a result of acquired metabolic problems or medication. Certain types of chemotherapy, such as those used to treat some leukemias, increase the likelihood of gout development.
The most common type of gout or crystal-induced arthritis is the monosodium urate type, which is characterized by uric acid crystals in the synovial fluid. Other kinds of gout arise due to the presence of various types of calcium crystals.
Chronic gout, also known as gouty arthritis, affects several joints. Uric acid crystal deposits build up in multiple areas of the body: synovial fluids, tissues, tendons, vertebrae, elbows, between cartilage and bones, in the cartilage itself, and in the skin. The course of chronic gout is highly variable there may be chronic low-grade discomfort accompanied by mild flare-ups intermittently, or it may result from severe episodes, which create chronic deterioration of the involved tissues.
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How Can High Uric Acid Cause Heel Pain
So, why does gout show up in the feet ? Uric acid is very sensitive to cooler temperatures. As it circulates throughout the body and reaches the feet , the liquid uric acid crystalizes, leading to pain in the joints of the big toe or joint of the heel .
Uric acid levels rise when your body breaks down purines. Purines are found in foods like red meat and alcohol, as well as in certain medications and naturally in the human body .
Most of the time, your body is able to manage uric acid levels effectively, simply dumping the uric acid into your kidneys where it is excreted as urine. However, when uric acid levels get high enough, your kidneys may struggle to keep up, and uric acid may stay in your bloodstream where it causes inflammation, pain, and swelling as it crystallizes in the joints of the foot.
What Happens At Your Appointment
The GP may ask about your diet and if you drink alcohol.
They may refer you to see a specialist and arrange a blood test and scan. Sometimes a thin needle is used to take a sample of fluid from inside the affected joint, to test it.
The blood test will find out how much of a chemical called uric acid there is in your blood.
Having too much uric acid in your blood can lead to crystals forming around your joints, which causes pain.
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How Uric Acid Crystals Form
Infographic
The build-up of uric acid crystals begins with purines, a chemical compound found in many foods.
- When the body metabolizes purines, it produces a substance called uric acid.
- The uric acid enters the bloodstream.
- The kidneys filter the blood and normally filter out excess uric acid. This uric acid is then excreted via urine or stool .10
- If the kidneys cannot adequately filter out excess uric acid, or if the body produces too much uric acid, there will be too much uric acid in the bloodstream.
- Too much uric acid in the bloodstream is called hyperuricemia.
- In some people, hyperuricemia leads to the formation of uric acid crystals that collect in joint tissue, leading to painful symptoms.
An inability to adequately process and excrete uric acid accounts for an estimated 90% of gout cases.9 Other cases occur because a body produces too much uric acid.
Causes & Risk Factors
While natural gout remedies do help to relieve the pain and discomfort, for true healing its important to address the underlying causes of gout and address any risk factors you may have to prevent future gout attacks.
Gout Risk factors
1. Diet:
Consuming moderate to high levels of purine-rich foods including beef, seafood, alcohol, legumes, certain vegetables and fructose is a leading cause of gout.
2. Obesity:
When obese, more uric acid is produced and the kidneys may have a difficult time eliminating the excess.
3. High Blood Pressure:
Natural high blood pressure remedies can help bring your numbers into the normal range. Partner these treatments with regular exercise and stress-relieving activities for the best results.
4. Dehydration:
Stay hydrated by drinking a minimum of eight glasses of water each day. During the summer months or when exercising, be sure to drink more.
5. High Levels of Triglycerides:
Work to reduce your triglycerides by losing weight, avoiding sugary foods, reducing alcohol, and replacing unhealthy fats with healthy ones.
6. Diabetes:
Follow a diabetic diet plan and exercise regularly to lower your A1C numbers naturally.
7. Metabolic Syndrome:
Incorporate burst training and essential oils into your daily routine while following a diet for metabolic syndrome to reduce your chances of gout.
8. Heart Disease:
9. Kidney Disease:
10. Medications:
11. Genetics:
12. Trauma or Surgery:
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How Long Gout Pain Lasts
Characteristically, gout pain comes on rapidly and the joint becomes red and swollen, with the swelling reaching a peak within the first 24 hours of the attack, Dr. FitzGerald explains.
At first, gout usually affects just one joint, but can affect more than one joint, sometimes adjacent joints. Flares typically resolve on their own over the next seven to 14 days. Treating a gout flare with medications can help it resolve faster. Medications for gout flares typically include:
- Non-steroidal anti-inflammatory drugs , such as ibuprofen or naproxen
- Colchicine
- Glucocorticoids
A gout attack may occur only one or two times a year or even only a few times ever. However, gout can become chronic, leading to frequent attacks and flares that occur at least a few times a year or never completely resolve. Chronic gout can damage and deform joints and can sometimes be mistaken for other inflammatory diseases like rheumatoid arthritis.
How Common Is Gout In The Knee
As a general rule of thumb, if left untreated, gout tends to work its way up the body, Dr. Keenan explains.
For example, he cites research that shows 50 percent of patients experience their first gout attack in the big toe. If gout worsens, 35 percent of secondary flares occur in the knee, 40 percent in the midfoot and ankle, 30 percent in elbows and wrists, and 15 percent in fingers.
Its not uncommon for a person to experience their first gout flare in their knee and, after an X-ray or ultrasound, show signs of gout in the foot, he adds.
Gout can afflict both knees, but typically is felt more strongly in one knee where arthritis from general wear is worse.
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What Are Symptoms Of Gout
Chances are you wont even know you have gout until youve experienced your first painful attack, often at night. Symptoms may not develop for years, but these often include:
- Arthritis that develops quickly, resulting in a swollen, red, and warm joint with limited movement
- An arthritis attack in only one joint often the big toe, as well as a foot, ankle, or knee
- Bright red or purplish skin around the affected joint
- More than one attack of acute arthritis
Who Is At Risk Of Gout
Gout is sometimes called the disease of kings because of a false link to overindulgence in food and alcohol. Anyone can get the condition, but certain factors can increase your risk:
- Gender: Males are more likely to get gout than females.
- Age: Middle-aged and older men and women after menopause are more at risk for gout.
- Obesity
- Family history
- Diet: A diet high in purines, which are broken down into uric acid, can lead to gout. High purine foods include meats like bacon, turkey, veal, venison, and liver, and seafood like anchovies, sardines, mussels, codfish, scallops, trout, and haddock. High fructose foods and drinks such as soda pop also can increase your risk.
- Alcohol use
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What Are The Symptoms Of Gout In Your Feet
Some symptoms of gout in the feet include a persistent discomfort, inflammation and extreme pain in the joints of the feet. Symptoms of gout often occur suddenly at night and may recur continuously unless the condition is treated, notes WebMD.
Gout is a type of arthritis and may affect the joints of the knees, wrist, toes, ankles and hands. Gout usually occurs when urate crystals accumulate in the affected joint, according to Mayo Clinic. This accumulation leads to inflammation of the region and pain.
People with high amounts of uric acid in their blood are likely to suffer from this condition. Other risk factors associated with this condition include being overweight, eating foods that tend to increase uric acid levels in the body, certain medical conditions, family history, age and gender.
Individuals with gout are likely to experience a swelling of the affected area. Redness and an intense pain in the big toe are common symptoms of this condition. Pain caused by gout is intense and may easily be worsened by a simple touch on the inflamed area. Adequate rest, the use of ice to reduce swelling and taking drugs prescribed by a doctor are among the treatment options available for gout.
Am I At Risk Of Having Gout
Youre more likely to have a gout attack if you:
- are male
- have a family history of gout
- have elevated levels of uric acid in the blood
- drink too much alcohol
- eat a diet high in purines such as meat, sweetbreads, offal, shellfish, and fructose
- are overweight or obese
- use diuretics
- have type 2 diabetes, high blood pressure or high cholesterol these conditions can mean that your kidneys are less able to flush out the urates
- have kidney disease
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Why Do I Have Gout
Gout is caused by a build-up of uric acid in your blood, a condition called hyperuricemia. When a persons uric acid levels rise, so does the risk of a gout flare-up.
Uric acid is always present in our blood, and it is eliminated when we urinate. When someone has gout, the uric acid builds up and crystallizes within the joints.
Foot gout can also be attributed to heredity. The National Institute of Arthritis and Musculoskeletal and Skin Diseases conducted a study showing that 18 percent of people who develop gout have a family history of the condition.
Numerous other medical conditions also increase the risk of developing gout. These conditions include:
- Diabetes
Other risk factors for developing gout include:
- Alcohol consumption
- Consumption of foods rich in purine
- Exposure to lead in the environment
- Being male
- Medication
When you drink alcohol, you increase the concentration of uric acid in your body. When this happens, you increase your risk of developing gout. Abusing alcohol can also affect other parts of your body, including your kidneys, which are responsible for eliminating uric acid.
Certain medications such as aspirin, diuretics, and levodopa can also interfere with your bodys ability to remove uric acid, causing a build-up.