Surviving Covid-19: Gout

Man with Gout in Extreme Pain

Surviving COVID-19 without my Podiatrist

Gout

Welcome to the third installment of my blog, Surviving COVID-19 without my Podiatrist. Each article provides at home self help guidance to common foot ailments.The information provided in our blog is not intended to be medical diagnosis or treatment. The purpose of my blog is to help the reader better understand their foot condition during the current pandemic where access to medical care can be limited.

If you have any further questions about this topic, as well as any other subject you would liked addressed, please email me at drreyes@ngfootclinic.com.

Inside look at Gout

Gout

So what exactly is gout?

Gout is an inflammatory arthritis caused by the build-up of uric acid crystals inside of the joint. The build up of theses uric acid crystals comes from the  breakdown or metabolizing of purines. Purines are found in many protein rich foods. When the body digests these foods, the purines are broken down into a substance called uric acid, which is then delivered to the bloodstream. The uric acid is then filtered out by our kidneys and secreted via urine and stool.

However when you produce too much uric acid in the bloodstream, you develop a condition called hyperuricemia. In some patients, this excess uric acid forms crystals that collect in the joints, resulting in gout.

Symptoms of Gout

Perhaps what distinguishes gout from most arthritis conditions is how fast it strikes. Conditions like osteoarthritis develop gradually with age and joint wear and tear. Gout strikes quickly, severely and without any warning. The pain and inflammation is so severe that it is often confused for serious medical conditions, such as infections.

One of my gout patients described the patient as “tiny shards of broken glass cutting inside your bone.”

The affected joint turns red, hot, swollen and extremely tender to the touch. Patients can’t even allow for bed sheets to touch the area.

Podagra?

This tidbit of information will make for some clever trivia conversation at your next cocktail party. Although gout can affect any joint in the body, over 80% of all acute gout cases involve the great toe joint of the foot. Therefore acquiring its own name as a condition, podagra. Pod is from the Greek root meaning foot and agra means sour. So this is the reason your friendly neighborhood is addressing this topic. It is safe to say that podiatrist treat more acute gout then any other medical specialty.

So who gets gout?

Although this blog is intended for patients that already have been diagnosed with gout. However, due to its rapid onset, I find that most of my patients always want to know why they got gout all of a sudden. Here is another
fun fact to make you look really smart at dinner parties… gout is commonly nicknamed the “king’s disease.” This is because many centuries ago gout was associated with aristocrats that ate rich meats and wine. Gout’s most
famous sufferers were Alexander the Great, King Henry VIII and Benjamin Franklin.

There is still no clear medical understanding of why some people get gout… however, there are a set of risk factors:

  • Diet: A diet high in meats, seafood and/or high in sugar (including corn syrup)
  • Alcohol: Drinking alcohol, particularly beer which is high in purines.
  • Gender: Men are more likely to develop gout.
  • Age: Gout typically starts to affect men between ages 30-50
  • Excessive weight: People who are overweight have a greater risk to develop gout.
  • Race: African Americans are twice as likely to develop gout then Caucasians
  • Medications: Taking diuretics, aspirin, and/or levodopa (Parkinson’s) can cause gout, kidney disease or failure.
  • Lead exposure: People exposed to lead have a higher incidence of gout.
  • Family history: If someone your in family has had gout, unfortunately you have a greater chance of having it.

I am quarantined with Gout… what now?

Here are seven steps I suggest in order to alleviate your pain.

  1. Make sure it is gout and not an infection or something similar. Gout can resemble an infection except for the lack of a fever and the exquisite pain to the touch. If you have any doubts please consult you primary care doctor.
  2. Get complete bed rest and keep your foot elevated.
  3. Try icing the affected area. Place a soft towel over it first and then an ice pack. Do not try to apply pressure or wrap the ice pack onto the foot. This will cause great pain. Ice it twice a day for 2 to 3 minutes, if you can tolerate it.
  1. Keep your foot clothing free. Remember the area is going to be very tender to the touch. So avoid closed shoes, slippers with straps or even socks on the foot.
  2. Drink a lot of water in order to help wash out the uric acid from your system. I suggest drinking an eight (8) ounce glass of water with a teaspoon of apple cider vinegar daily. The vinegar contains malic acid which helps breakdown the uric acid crystals in the joint.
  3. If you don’t have a history of kidney problems, begin taking an over the counter NSAID. Gout responds well to Ibuprofen (Advil, Motrin). Begin taking 400 mg three times a day for the first 48 hours.
  4. Change your diet immediately! Eliminate alcohol, meats (beef, turkey, veal, liver), herring, tuna, anchovies and sugar from your diet.

The pain should start getting better in about 2 to 3 days.The acute gouty attack should be gone in about 10 days. If the symptoms don’t improve or are getting worse you need to seek immediate medical attention.

What can I do to prevent a gout attack in the future?

Whether a patient suffers from gout due to family history, lifestyle or secondary to a medication or other condition, new research is showing that diet modification is by far the single most effective way of preventing further gout flare ups.

If you are overweight try to lose weight using a healthy change to your eating habits, that will keep the weight off. There are many nutritional guidelines available in order to assist you.

Implement a daily exercise regimen and try to exercise at least three times a week. A walking regimen is a very good start. Remember gout is a type of arthritis, therefore like most forms of arthritis a joint that regularly moves is the best deterrent to chronic flare ups. Eat cherries, yes that’s what I said. Cherries contain a substance called anthocyanins which are thought to reduce inflammation.There are some studies coming out of Germany that have demonstrated that they can lower the risk of gout attacks.

However in spite of these lifestyle changes, there are patients who will require medications to control uric acid production in their metabolism.

I hope this article helps you be feel better and helps you cope with your condition until you have the opportunity to see your podiatrist. If you have any questions I am always available, drop a comment here, email me, or send me a DM through any of my social media pages.