Recognizing and Treating Lower Extremity Gout

Recognizing and Treating Lower Extremity Gout

Gout is an inflammatory arthritis that results from high uric acid in the blood, from either the body’s overproduction or under excretion of uric acid.  It typically presents with acute onset and can be recurrent.  The first metatarsophalangeal joint (MPJ) is involved in 90% of individuals with gout. Gout can result in joint deterioration and destruction. 

            For the last two years, gout has been much more recognizable to the public in print, TV, and other forms of media.  The painful condition of gout is now more appreciated as the number of gout medications, formulations and reformulations has changed the landscape for the public and patient base, and thus changed the management by physicians. 

The actual number of true gout cases is likely underestimated.  Many times patients and physicians treat this with OTC analgesics or anti-inflammatories without the proper diagnosis and workup for gout.  High uric acid in the blood is the cause of gout.  There is an increasing prevalence with significant presence of one or more disorders (or diseases) including cardiovascular disease, hypertension, renal insufficiency and metabolic syndrome. 

Researchers have stated that gout affects approximately 5 to 6 million people in the United States with prevalence on the rise. Gout reportedly occurs more in men that in women, affecting 2 percent of men older than 30 years of age.  Risk factors include being male, postmenopausal, a strong family history, kidney disease, organ transplants, excessive alcohol use, a diet high in purines, (red meat and seafood) metabolic syndrome, obesity, dehydration, and exercise.   Studies have shown that heavy alcohol use in general, particularly beer, increase the incidence of gout whereas moderate use of red wine, did not.

            It is well known that the incidence of gout is higher in people with increased dietary intake of purines, particularly meat and seafood, as well as ingestion of beer and spirits, soft drinks and fructose.  It is lower in those with increased intake of coffee, dairy products and vitamin C (all lower uric acid levels).  It must be clarified that coffee and tea can also increase uric acid levels and the presentation of gout.  Purine-rich foods such as fruits, vegetables and foods that include a high citrus content can affect the balance between urate reabsorption and secretion which is critically linked to the uric acid elimination in urine. 

            In conclusion, gout is relatively common inflammatory arthritis that occurs in all age groups.  It can be particularly debilitating disease, causing limitation of activity and lowering the quality of life.  It is now associated with the comorbidity of other systemic diseases. If you feel you may have gout or any symptoms of gout, see your doctor to help diagnose and treat this disease.