Gout: A Disease of the Big Toe that can Cause Big Problems
Gout is a form of arthritis caused by the accumulation of uric acid in the joints. It is an extremely painful disease. In most cases, it affects only one joint, most commonly the big toe. Gout is characterized by sudden, excruciating pain, swelling, redness, warmness and stiffness in the joint. Low-grade fever may also be a symptom. Gout sufferers will often experience intense pain whenever the affected area is moved. In addition, the inflammation of the swollen tissues around the joint also causes the skin to be swollen, tender, and sore even if it is slightly touched. The act of draping a blanket over the area, for example, would be very painful.
Gout usually affects the big toe, but can also attack other joints. These joints include the ankle, heel, instep, knee, wrist, elbow, fingers, and spine. A diagnosis is generally made on a clinical basis, although tests are often required to confirm the diagnosis of the disease. Blood tests commonly performed are full blood count, electrolytes, renal function, and erythrocyte sedimentation rate. They are used mainly to exclude other forms of arthritis.
There are four distinct stages of gout. They are asymptomatic, acute, intercritical, and chronic. The first stage is asymptomatic hyperuricemia. In this stage, the only symptom a person shows is elevated levels of uric acid in their blood. This stage does not usually require treatment. Acute gout, or acute gouty arthritis, is the second stage. In this stage, hyperuricemia has caused the deposit of uric acid crystals in joint spaces. This leads to a sudden onset of intense pain and swelling in the joints. Attacks commonly occur at night and can be triggered by stressful events, alcohol, drugs, or the presence of another illness. In the beginning, they may last between three to 10 days and can be months or years apart. As the disease progresses, the attacks can last longer and occur more frequently. The third stage is interval or intercritical gout and is the period between acute attacks. During this period, the sufferer does not have any symptoms and experiences normal joint function. The final stage of gout is chronic tophaceous gout. It is the most disabling stage and usually develops over a long period of time. In this stage, the disease has caused permanent damage to the affected joints and sometimes to the kidneys. This stage can be avoided with proper treatment.
The first line of treatment for gout is pain relief. Doctors often recommend drugs such as indometacin or other nonsteroidal anti-inflammatory drugs (or NSAIDs) such as ibuprofen or Preparation H, or intra-articular glucocorticoids, which are administered by a joint injection. If you want to learn more about gout and how it can be treated, speak to your doctor.
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