It was New Year’s Eve, so you went out, ate a nice juicy filet mignon, and drank a little more than you planned. Now it’s New Year’s Day, you wake up and your big toe joint is red, hot, and swollen. The pain is getting worse as the day goes on. The pain is so bad that it even hurts to have a bed sheet touching your foot. How did this happen? How did it develop so fast? What can be done?
Gout is a condition in which uric acid builds up and crystallizes in the joints of the body. The crystals damage the cartilage in joints and make movement very painful. Uric acid results from the breakdown of purines, a substance found in high protein foods like beef, seafood, and beans. Purines are also high in certain types of alcohol, especially beer. Uric acid is normally removed from the blood by the kidneys, but if overloaded, uric acid will find other places to deposit in the body. Uric acid crystals form easier in lower temperatures, so it chooses the feet, hands, and ears since those are the cooler parts of the body. The first gout attack usually happens in the big toe joint, but it can happen at other joints. The pain is the worst during the first 24 hours of the attack, and slowly subsides during the coming days. An attack can happen even if your current blood uric acid levels are low, so levels must always be watched.
Historically, this was known as a diease of the rich, since only the rich had enough meat to trigger a gouty attack. Now that we know the source of the pain, most people can manage their gout with medications and diet modifications. We’ll discuss those options next post.