Gout Treatment in Golden Valley, Minnesota
What causes gout?
Gout is an arthritic condition caused by too much uric acid in the blood stream. Uric acid is a natural substance produced by our body from the breakdown of food. The uric acid in the bloodstream is then filtered out by the kidneys and excreted in our urine. When the uric acid levels in the bloodstream get too high, our kidneys can’t filter enough of it out and uric acid crystals will form. These crystals then drop down by gravity, often settling around the big toe joint. Also high levels of uric acid can lead to the formation of kidney stones.
Are there different forms of gout?
There are two forms of gout: the hereditary form (passed down in the family), and the secondary form caused by medications or kidney problems.
In the hereditary form the body produces too much uric acid and the kidneys can’t filter all of it out. This tends to be more common in overweight males between the ages of 35-50.
The secondary form occurs when the body produces normal amounts of uric acid but the kidneys that filter the blood can’t get rid of the uric acid quickly enough. This is commonly seen in older people with kidney problems or those taking diuretics (water pills) to reduce blood pressure or swelling in their feet, ankles and legs. Diuretics will push urine out quicker but in the process will leave uric acid behind that can build up, leading to a gout attack.
How does gout manifest itself?
Gout manifests itself in two ways with either an acute attack or slow, chronic gout.
The acute attack is characterized by a sudden onset of pain (often over a 2-4 hour period) in a joint, usually at night. The pain can be so severe that even bed sheets touching the foot or air currents are painful. Intense redness, swelling and heat radiating off of the joint often occurs. Although knee, ankle, mid-foot and finger joints may be affected, about 50% or more of acute attacks affect the big toe joint. Also about 60% of those who have an attack will have a 2nd attack during the year. Patients with an acute attack are given emergency, same day appointments at the Westwood Foot Clinic.
There are also those with long-standing elevated uric acid levels that develop “slow, smoldering, chronic gout”. The condition causes the development of “tophi” – hard, painless deposits made of crystallized uric acid – to form around the joints and on the toes. These deposits can eventually eat away at bone causing deformity, crippling arthritis and skin ulceration. Those with gouty deposits are also prone to developing an acute attack from an injury or surgery to the foot.
What is the treatment for gout?
To stop the acute attack, Dr. Silver will often administer a long acting anesthetic to the joint to block the pain cycle along with a small amount of cortisone to reduce the inflammation. This is especially good for elderly patients who are on blood thinners and can’t take anti-inflammatory medications. For some patients, oral medications such as Indomethacin or Colchicine may be prescribed.
To control gout, prevent future acute attacks or even kidney stones it is essential to get the uric acid levels down to normal. A blood test is performed in our clinic to determine your uric acid level. It’s not uncommon for those with an acute attack to have levels at 1 ½ to 2 times normal. Once we know your baseline uric acid level, Allopurinol is given in increasing dosages over a three week period (to prevent side effects). After three weeks, a second blood test is taken to determine the correct dosage of the medication to keep your uric acid at normal levels. This medication often needs to be taken daily for years to come so patients are often referred back to their primary care physicians at this point for long term follow-up. There are also some patients whose conditions are more difficult to control that Dr. Silver will refer to a rheumatologist (arthritis specialist) for treatment.
For those with gouty deposits that cause deformity, it is usually necessary to surgically remove the bumps that are caused by gouty deposits. This procedure is done in the comfort of the Westwood Foot Clinic with the affected area numbed by a local anesthetic.
Hereditary gout can often be treated with diet alone. There are certain foods that are high in purines that cause elevated levels of uric acid. Below is the diet Dr. Silver recommends for all his patients with the hereditary form of gout. Sticking to this diet can prevent any problem from gout and you will also lose a few of those unwanted pounds!
Foods to avoid:
Seafood (especially shellfish): Studies show a 50% increase in gout with a diet high in seafood.
Red meat: Studies show a 40% increase in gout with a diet high in red, fatty, rich meats.
Beer & soft drinks: Eliminate or significantly reduce alcohol (especially beer) & carbonated beverage consumption.
Purine-rich fruits & vegetables (avoid excessive amounts of these):
- Citrus fruits/ juices
If you are struggling with Gout, call our office at (763) 231-2341 today to schedule an appointment with Dr. Silver.