Very painful joint? It could be GOUT!

The onset of painful joints in the feet and lower limb often has a myriad of potential causes. The nature of the pain, history of injury or trauma, pre-existing as well as current medical conditions all have to be considered when identifying and diagnosing joint pain. Some of the pain can be attributed to arthritic pain which has many varying causes. One of the common forms of arthritis in the joints is due to a condition called gout. Gout is often identified by joints that are swollen, hot and extremely painful to touch. The onset is often very sudden and takes the sufferer by surprise. Most of the joints in the body can be affected though the feet are a very common place to develop symptoms. Modern research shows that gout is much more common in men than in women.

Causes

The primary cause of gout is the accumulation of crystals of a chemical called uric acid inside the joint capsules. The uric acid crystals infiltrate joints when there has been a build-up of uric acid in the body (particularly in the bloodstream) which can be either due to an over production of uric acid by the body or an insufficient removal of uric acid by the kidneys.

Risk factors

A number of risk factors are involved with increased risk of developing gout. Some causes are lifestyle related whilst others are due to certain physical predispositions. The risk factors include but are not limited to:

Obesity
-Poor dietary habits that contribute to obesity can often lead to increased levels of uric acid in the blood thereby increasing a persons risk of developing gout.

Poorly functioning kidneys
-If kidneys are not functioning as optimally as they can be, then their ability to filter out the uric acid from the bloodstream can be diminished leading to levels rising in the body.

Having generally high levels of urate in the body
Excessive consumption of alcohol, red meat, shellfish or fructose.
– When each of the above are broken down in the body, they produce a chemical called ‘purine’ which when converted to other chemicals leaves the byproduct of uric acid.

Using diuretics
-Diuretics are medications that act on the kidneys promoting the removal of water from the body. An excessive removal of water can lead to increased concentration of urea and in particular  uric acid in the body.

Dehydration.
Post-operative complication.
Injury to the joint.

Treatments

Most attacks of gout can resolve themselves within a matter of a week or two without the use of medication. If medication is employed, the symptoms can be alleviated within a day or two. Although the symptoms may be eased, there is a possibility that uric acid crystals remain in the joint, potentially precipitating another attack. As such, a visit to a podiatrist for assessment is often advised. A podiatrist can diagnose the condition and if required provide you with appropriate referrals to have the condition treated. Sometimes, a referral to see your GP for medication and further assessment may be warranted. Your doctor may send you for a blood test to confirm the presence of higher uric acid levels in the body and depending on the severity of the joint swelling your doctor may aspirate the fluid. This may actually provide immediate relief to the region. Alongside aspiration, medication may be prescribed with the aim of reducing joint swelling and/or uric acid levels. These medications may be either non-steroidal anti-inflammatory drugs, corticosteroid injections or a uric acid lowering medication called colchicine.
Your doctor may also screen you for the presence of other medical conditions which can potentially be contributing to the development of your gout.

There are a number of things that a person can do to reduce their risks of developing gouty arthritis. Many of these are associated with lifestyle factor changes and include:

– Maintaining a healthy body weight.
– Drinking plenty of water daily
– Exercising regularly.
– Avoiding excessive consumption of alcohol, fatty foods, red meats, fructose or shellfish.
– Seeking help from your doctor and podiatrist will help you diagnose, and manage the condition and pain and discuss prevention.

If you or anyone you know has painful joints and that you suspect could be due to gout, call us at The Podiatry Centre. We are here to help.

 Dr Anel Kapur (Podiatrist)