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The Scenario:
Fred is the kind of guy who loves to indulge himself. You won't find a more enthusiastic connoisseur of rich food and good wine. Of course, he is a bit overweight. And he's not exactly "Mr. Exercise." His doctor has talked to him about watching the fat in his diet and cutting down on his alcohol intake, but he finds it pretty hard to turn down a good meal.
One day, out of the blue, Fred woke up with a pain in his foot. Actually, it seemed to be coming from the joint of his big toe. He hadn't done anything unusual and hadn't bumped it on anything. Yet it was quite sore. As the day progressed, the pain increased. By the next day he found that the joint at the base of his big toe was red and swollen. At that point he was having a lot of pain. Any movement of the toe, even any rubbing of his bed sheets on the toe caused intense discomfort. Tylenol didn't touch the pain. Ice and heat also had no appreciable effect.
Questions:
Answer:
His is a classic case of gout. Legend has it that people who indulge in rich foods and alcohol get gouty arthritis. Although diet may be important, it is often starvation, or a period of intense fasting, a binge in alcohol drinking, even physical or emotional stress, that are among the common factors associated with gout.
What is gout? Well, it starts with the general recognition that what Fred has is acute arthritis. We know it is arthritis because the joint is red, warm, swollen, and painful. Calling it gouty arthritis is just playing the odds as there are many causes of arthritis. The way his has occurred and the location of the arthritis strongly suggest gout as the cause. To know for sure, you could stick a needle into the joint, aspirate some fluid, and check it for the presence of uric acid crystals. Sometimes that is done. While gout can affect many other joints, the first joint of the large toe is the most commonly affected. The reason for this is not known.
Gouty arthritis is caused by uric acid, a chemical normally present in the body as a by-product of metabolism. People with gout tend to have higher blood uric acid levels. Often there is a genetic predisposition. However, alcohol, and starvation both reduce the kidney's capacity to get rid of excess uric acid, which is the reason why these activities can lead to a gouty attack. Although diets with reduced "purines" (found in high levels in foods such as sardines, dried peas, and liver) may help decrease blood uric acid, medications are much more effective.
Generally, anti-inflammatory medications (such as Indocin) bring about a dramatic relief of symptoms. I was amazed at how many people were familiar with the medications used for gout. An older drug called colchicine is also used. People who have recurrent attacks are sometimes placed on a daily medication that lowers the uric acid level and prevents the attacks from occurring. If Fred catches it early, he will feel much better within a couple of days. For more information, check out http://www.arthritis.org/facts/fs/fs.gout.html.
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