Often, on a Monday morning, after indulging in red wine and red meat, people wake up with a painful, warm, red and very uncomfortable big toe. The first time this happens, it may be quite a shock as gout can be very painful, with some people describing it as a burning flame in the joint.
Crystals in the joints
An acute gout attack is anything but a mild discomfort, and is so debilitatingly painful, that patients can barely walk on the affected foot. A gout attack is brought on when uric acid levels in the blood rise and cause crystals to form in a joint. This leads to significant inflammation in the joint.
Uric acid is formed when the body breaks down purines (substances found in red meat) to uric acid. Alcohol also leads to uric acid formation. The kidneys can't keep up with excreting the substance, and before long the levels in the blood rise high enough for crystals to form in the joints.
How do a doctor will go about diagnosing and treating an acute gout attack:
Your doctor will first take a full history. The more detailed the history, the easier it is to diagnose the condition.
1. Is this the first time you experience an episode of this kind?
2. Details about your diet (including alcohol and meat ingestion)
3. Medical conditions you suffer from: e.g. high blood pressure and diabetes
4. Medications you take: e.g. thiazide. Hydrochlorothiazide (Ridaq) used to treat high blood pressure, and aspirin, can also elevate uric acid levels.
5. Questions about onset of the pain, injuries in the affected joint and if the pain radiates
6. Your doctor will also ask if you've ever had a bleeding stomach ulcer as some medications used to treat gout are contra-indicated if you have ulcers.
Your doctor will also exclude other causes of joint pain like infection or fractures in the joint. This can be done by proper examination.
On examination, your doctor will check your blood pressure, look for signs of infection and exclude any other causes for a painful joint.
Examination of the joint might be uncomfortable or even painful. Your doctor will palpate the joint, feel for a difference in temperature, move the joint and check for bruising. He will also assess the pulses of your limb.
Your doctor might order an X-ray to rule out any other causes of inflammation. He will most probably do blood test to check the uric acid level of your blood. A high level is indicative of gout.
In some cases, a doctor will place a needle in the joint and withdraw some of the fluid to send off to the lab where the fluid will be checked for urate crystals. This is not done routinely though.
Treatment of gout
The cornerstone of treating an acute gout attack is to ease the inflammation. This can be done by non-steroidal anti-inflammatory drugs like brufen, celecoxib or diclofenac. A drug called colchicine is also used to ease the pain associated with gout. The only problem with colchcine is that some patients experience significant nausea and abdominal discomfort.
Steroids like prednisone is also used to suppress the inflammatory response. These are usually given in pill form over a couple of days.
Preventing repeated gout attacks is important. This can be done by using drugs that either reduce the formation of uric acid (a class of drugs called xanthine oxidase inhibitors, like alluperinol) or increasing the excretion of uric acid by the kidneys from the blood, like probenacid.
Lifestyle changes form part of the treatment. This include lowering alcohol and red meat intake, losing weight and regular exercise.