What is Gout?
Gout is one of the commonest forms of inflammatory arthritis.
It is caused by the crystallisation of uric acid within the joints (1).
What Causes Gout
The exact cause of Gout is unclear. It involves deposition of monosodium urate crystals in tissues (1).
- Typically higher uric acid levels in the blood are present in those with gout but it is not always correct
- In one study normal serum uric acid levels were found in 63.3% of the patients with acute gout attack (2)
- Even with higher uric acid levels above 9mg/dl only 5% of these people will develop gout (1).
It has been suggested that the following increase the risk of someone developing gout:
- Diet. Eating a diet rich in meat and seafood and drinking beverages sweetened with fruit sugar (fructose) increase levels of uric acid, which increase your risk of gout. Alcohol consumption, especially of beer, also increases the risk of gout.
- Medical conditions. Certain diseases and conditions increase your risk of gout. These include untreated high blood pressure and chronic conditions such as diabetes, metabolic syndrome, and heart and kidney diseases.
- Certain medications. The use of thiazide diuretics — commonly used to treat hypertension — and low-dose aspirin.
- Family history of gout. If other members of your family have had gout, you’re more likely to develop the disease.
- Age and sex. Gout occurs more often in men.
- Recent surgery or trauma. Experiencing recent surgery or trauma has been associated with an increased risk of developing a gout attack.
Diagnosis of Gout
Diagnosis is usually based or symptoms and a complete assessment of your foot and ankle.
Diagnosis of gout can occur with:
- Blood tests (1)
- Imaging of the joint (X-ray)
- Aspiration of the joint
- Ultrasound Imaging is also beneficial in the diagnosis of gout.
The following ultrasound images show a toe with gout – the double contour sign and distention of the joint capsule with tophaceous material sometimes present.
Treatment of Gout
The management of gout involves treating both the flares and the hyperuricaemia itself.
Treatment of the flares can be with Non-Steroidal Anti- Inflammatories or Colchicine (1).
Misuse of colchicine is frequent in routine practice. The drug should never be used at a high dose to treat flares because low doses are as effective and are better tolerated than high doses.
This drug, which has a narrow therapeutic window, is mainly metabolized through two proteins (P-glycoprotein and CYP3A4), which explains the multiple drug-to-drug interactions (1).
In patients with contraindications or who cannot tolerate NSAIDs or colchicine. IL-1 blockers are an excellent therapeutic option. (1).
Treatment of the hyperuricaemia can be achieved with urate-lowering therapy (ULT). The most common ULT is a xanthine oxidase inhibitors (i.e. allopurinol and febuxostat). (1).
1. Ragab, G., Elshahaly, M., & Bardin, T. (2017). Gout: An old disease in new perspective – A review. Journal of Advanced Research, 8(5), 495-511.
2. Bădulescu, M., Macovei, L., & Rezuş, E. (2014). Acute gout attack with normal serum uric acid levels. Revista Medico-Chirurgicala a Societatii De Medici Si Naturalisti Din Iasi, 118(4), 942-945
Expert Podiatrists for the treatment of Gout servicing the areas of Northcote, Thornbury, Fitzroy, North Fitzroy, Carlton, North Carlton, Alphington, Fairfield, Brunswick, Coburg and Preston
Call The Ankle Foot and Orthotic Centre for diagnosis and advice on professional management and treatment options.