Which Joints Are Involved In Gouty Arthritis And Why Is It Most Common In The Foot
As with all other known types of arthritis, Gout has particular joints it tends to attack, and the foot is its most common location. Gout especially favors the bunion joint, known as the first metatarsophalangeal joint , but the ankle, midfoot and knee are also common locations, as is the bursa that overlies the elbow.
The bunion joint is the first joint involved in 75% of patients and is ultimately involved in over 90% of those with this condition. . It is thought that this joint is especially involved in gout because it is the joint that receives the highest pounds per square inch of pressure when walking or running.
Late in gout, if untreated, multiple joints can be involved, including the fingers and wrists. The shoulder joint is very rarely involved by gout and the same is true of the hip.
Figure 5: Location of Gout Attacks
The Four Stages Of Gout
Gout is best understood by seeing it as having four phases or stages :
Stage 1: High uric acid
Elevated uric acid without gout or kidney stone, this stage has no symptoms and is generally not treated.
Stage 2: Acute flares
This stage is marked by acute gout attacks causing pain and inflammation in one or more joints.
Stage 3: Intercritical periods
These are periods of time between acute attacks, during which a person feels normal but is at risk for recurrence of acute attacks.
Stage 4: Advanced gout
This is a stage of chronic gouty arthritis, in which there are lumps of uric acid, or tophi , frequent attacks of acute gout, and often a degree of pain even between attacks .
Figure 1: Stages of Gout
Figure 2: Illustration of Toe Joint with Gouty Tophus. normal toe joint Urate crystals, shown in white, at the “bunion joint,” represent a gouty tophus.)
Figure 3: Progression of Gout
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:
You May Like: What Is A Home Remedy For Gout
What Can Trigger A Gout Attack
Several things can cause the crystals to shake loose into your joint cavity, triggering an attack. These include:
- a knock or injury to the joint
- an illness that may make you feverish
- having an operation
- having an unusually large meal, especially a fatty meal
- drinking too much alcohol
- starting urate lowering therapy, especially at a high dose, or not taking your treatment regularly each day.
How Does A Doctor Diagnose Ankle Gout
“A doctor might an order an X-ray to look for fracture or other injury,” says Dr. Siaton. “In someone with untreated, long-standing gout, certain findings, such as bone erosion, can be seen on the X-ray.”
Doctors can order a blood test to check for elevated uric acid levels, but they probably won’t do the test during a flare-up.
“It is not as helpful to check uric acid during a flare, as it is lower when the uric acid deposits in a joint during a flare,” Dr. Seligman.
Occasionally, fluid is drawn from a needle from the ankle joint to identify urate crystals.
Recommended Reading: Is Clam Chowder Bad For Gout
When Is Surgery Considered For Gout
The question of surgery for gout most commonly comes up when a patient has a large clump of urate crystals , which is causing problems. This may be if the tophus is on the bottom of the foot, and the person has difficulty walking on it, or on the side of the foot making it hard to wear shoes. An especially difficult problem is when the urate crystals inside the tophus break out to the skin surface. This then can allow bacteria a point of entry, which can lead to infection, which could even track back to the bone. Whenever possible, however, we try to avoid surgery to remove tophi. The problem is that the crystals are often extensive, and track back to the bone, so there is not a good healing surface once the tophus is removed. In some rare cases, such as when a tophus is infected or when its location is causing major disability, surgical removal may be considered.
Since it is hard to heal the skin after a tophus is removed, a skin graft may be needed. For this reason, we often try hard to manage the tophus medically. If we give high doses of medication to lower the urate level, such as allopurinol, over time the tophus will gradually reabsorb. In severe cases, we may consider using the intravenous medication pegloticase , since it lowers the urate level the most dramatically, and can lead to the fastest shrinkage of the tophus.
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.
Recommended Reading: Can Gout Be In The Ankle
How Is Gout Managed
Here’s the truth: there is no cure for gout, although there are many ways to treat it and prevent flare-ups.
Oddly enough, some people only have a gout flare-up once, while others have flare-ups more often.
So how might you avoid future flare-ups? It makes sense to avoid high-purine foods, but eating a purine-free diet is pretty hard to do.
And though elevated uric acids are a precursor to a gout attack, having high levels doesn’t mean you’ll automatically have an attack. Still, eating and drinking excessive amounts of high-purine foods isn’t good for anyone.
The Pathology Of Gout
Gout is primarily a metabolic disorder in which uric acid accumulates in blood and tissues. When tissue levels reach saturation, needle-like crystals form, causing inflammation. This occurs most commonly in the cooler joints, notably the metatarsophalangeal joint of the big toe.
Many people with hyperuricemia never develop gout, but those with the highest levels are most likely to suffer episodes. Hyperuricemia may also lead to kidney stones.
Also Check: Is Salsa Bad For Gout
Why Does My Ankle Hurt
Figuring out why your ankle is throbbing can be a guessing game.
Was it from rolling your ankle in the backyard yesterday? Or could it be tendonitis from the extra miles you can this week?
Maybe it’s from gout, a type of arthritis sometimes known as “the disease of kings” because only the monarchs of yesteryear could afford the food and drinks that are known to exacerbate its symptoms.
Gout cases have been on the rise in recent years due to the increasing obesity rate, although anyone can get gout. Just as the royalty’s diet was to blame for many gout symptoms recorded in history, our modern diets are one reason the disease is on the rise.
And while historically gout was associated with the big toe, the condition is becoming more common in other placesjoints like the hands, foot, or ankle.
Diagnosing ankle symptoms isn’t always easy. Even some doctors mistake ankle pain for something other than gout.
“Patients are often misdiagnosed with sprains, cellulitis, and other disorders when gout is unrecognized due to both severe pain and appearance,” explains Victoria Seligman, MD, a rheumatologist with UCHealth Rheumatology Clinic Cherry Creek in Denver.
Here’s how to know when your ankle symptoms are due to gout and how to treat them.
Some Home Remedies For Gout
- Try apple cider vinegar Helping to make the body more alkaline, apple cider vinegar has become a well-known proven solution for countless ailments, including gout. Try mixing 1-2 tablespoons of apple cider vinegar in 8 ounces of water. You can either drink it in one sitting or sip on it over time try both methods and see which is more effective. This solution can reduce pain by 90% within a day or two. Note: Be sure to use organic apple cider vinegar with the mother.
- Baking Soda Among other home remedies for gout is the use of baking soda. Mixing baking soda in water can effectively relieve pain almost instantly, though it may take 1-2 days. Mix 1/2 teaspoon baking soda in 8 oz. of water and drink it in one sitting. You may need to repeat this a few times a day, taking as much as 3 teaspoons total. Reduce the dose as the pain goes away. Note: The maximum recommended dose is 4 teaspoons throughout the day. Lastly, use caution if you suffer from hypertension, as baking soda may raise blood pressure when taken in larger amounts.
- Eliminate sugar and soda Whether its caffeinated or not, drinking two sodas each day can increase your risk of gout by a whopping 85%! Why? Sugar! Reduce sugar intake dramatically and risk of experiencing gout will dramatically drop.
- Hydrate Drink plenty of water. This will help flush out the excess uric acid.
- Reduce alcohol consumption Alcohol dehydrates the body and could raise uric acid levels in the blood.
- Reduce caffeine intake.
Also Check: Symptoms Of Gout In Feet And Toes
What Else Should I Ask My Healthcare Provider About Gout
Consider asking your healthcare provider:
- What is causing the gout?
- Do I have any joint damage?
- What can I do to prevent future attacks?
- Can any gout medications help me?
- How long will I need to take gout medications?
A note from Cleveland Clinic
Gout is a painful form of arthritis. Extra uric acid in your body creates sharp crystals in the joints, leading to swelling and extreme tenderness. Gout usually starts in the big toe but can affect other joints. Gout is a treatable condition, and the uric acid level can be decreased by medication and lifestyle changes. Talk to your healthcare provider about medications that can reduce uric acid levels. They can also discuss changes you can make to your diet and lifestyle to prevent and reduce gout attacks.
Last reviewed by a Cleveland Clinic medical professional on 11/15/2020.
How To Treat A Gout Flare
Different medications can be used to address gout, but when youre in the midst of a gout flare, the number-one goal is pain management. Because the pain is so severe, its really important to try to bring it under control quickly, says Dr. Saag.
Even though gout is caused by uric acid buildup, now is not the time to start a drug thats specifically designed to lower uric acid levels.
Instead, your doctor will likely prescribe a higher dose of a non-steroidal anti-inflammatory drug , such as naproxen, or a steroid medication like prednisone. Your doctor might also inject a steroid directly into the affected joint, or, if the pain is bad enough, start you on an intravenous version of it, says Dr. Saag.
Colchicin is another medication that is sometimes used to manage gout flares. This drug is not a traditional pain reliever, since it doesnt seem to relieve pain caused by other conditions. According to a Cochrane Review, about 40 out of 100 people who use colchine during a gout attack rated their pain 50 percent lower than those who took a placebo, but theres also a high risk of side effects like vomiting, nausea, and diarrhea, especially when taken at high doses.
If youve had gout flares before and are now seeing a new provider or are being treated in the emergency room, be sure to tell the doctor about the treatments youve previously tried during an acute episode and how well they worked for you.
Recommended Reading: Baking Soda And Water For Gout
What Is Uric Acid
Uric acid is a waste byproduct of purine breakdown in the body. Purines are naturally produced in the body, as well as found in some foods. As purines are broken down, uric acid is created. Normally uric acid is either reabsorbed in the body or excreted via the urine and feces.
When there are more purines in the body than it can process, uric acid builds up in the bloodstream. This is called hyperuricemia. Hyperuricemia can cause gout and/or kidney stones in some people, while others have no signs or symptoms at all.
Treatment for gout often includes medications, diet modification, and lifestyle changes, such as managing weight and quitting smoking. The foods you eat can have a direct impact on gout flares.
During a gout attack, modifying your diet may help decrease the length of the flare. Continuing to follow a gout-friendly diet, specifically a low-purine diet, may help prevent the risk of future gout attacks up to five fold.
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.
Also Check: Diet For Gout And Kidney Stones
If You Are Having Repeated Attacks See Your Doctor
Some patients can go a long time between attacks. In fact, for 62 percent of patients the next attack will be more than a year away, and some won’t have another attack in the next 10 years. However, if you begin to have more frequent attacks, talk to your doctor about escalating treatment. People think its normal to have flares every now and then, but its not. The gout can be doing damage to your joints. It means you still have too much uric acid, says Shakouri. In particular, ask about allpurinol. It wont help with an acute attack but will help prevent future attacks by reducing uric acid production.
Immediate Gout Pain Relief: What Are Your Options
Generally, you can take simple steps to get the pain and swelling under control. Examples include ice, compression of the joint and rest from sport. Also, you need to keep well hydrated and avoid alcohol.
Medications from your doctor can help. Anti-inflammatory tablets such as ibuprofen can stop an acute attack if taken early. Similarly, a drug called colchicine can stop gout in its tracks if taken in the first 24 hours. Often, the dose of colchicine is one tablet three times a day decreasing to twice a day after a week as the pain settles.
Read Also: How Long Can A Gout Flare Up Last
Gout In Ankle: Symptoms And Home Remedies
*This page may contain affiliate links. When you buy through these links, we may earn a small commission at no extra cost to you.
Arthritis is basically a joint disorder that causes inflammation in one or more joints of the body. As such there are more than 100 types of arthritis.
But the most common ones can be classified as osteoarthritis, rheumatoid arthritis, ankylosing spondylosis, gout, etc.
What Is Gout?
In medical terms, gout is a complex form of inflammatory arthritis condition which is caused due to the build-up of uric acid.
Although it can affect varied body parts, it is most common in the joints of the foot and big toe.
The first and foremost diagnostic tool helpful for ruling out gout in the foot or ankle is by proper physical examination.
With mere examination, most experienced physicians can confirm the existence of gout in the ankle joint.
In case of a doubtful diagnosis, you can go for a complete blood test added with levels of blood uric acid check-up. Most of the time blood test will give you a clear diagnosis of the condition.
In case if the blood reports also fail to rule out gout in the foot then your doctor can use other diagnostic tools like imaging techniques.
The major imaging techniques which help in confirming the ankle gout are X-rays, CT-Scan, MRIs, etc.
Even sometimes the tests like bone density test and bone biopsy also help in confirming gout in the ankle and foot.