A recent study has proven the long held belief that a gout attack is more likely to occur at night. Dr. Hyon Choi from Boston University School of Medicine published an article online in Arthritis & Rheumatism that shows that persons have a 2.36 greater chance of having a gout attack at night than in the daytime. It is believed that the lowered body temperature and dehydration during sleep may be contributing factors as well as a change in hormone levels.
A gout attack during the holiday can hinder your holiday plans and stop all your fun. Changes in your diet, including overindulging in certain foods and beverages, can trigger gouty attacks this time of year. Gout attacks are extremely painful and come on suddenly, mostly at night. They are caused when uric acid accumulates in the tissues or a joint and crystallizes. This most commonly occurs in the big toe joint.
Uric acid is the result of the breakdown of purines -- chemicals that are found naturally in our bodies and in foods, especially proteins. Some people develop gout because their kidneys have difficulty eliminating normal amounts of uric acid, while others produce too much uric acid. Eating foods that are high in purines also contribute to uric acid build-up and can trigger a gout attack. Uric acid is present in the blood and is eliminated in the urine, but in people who have gout, uric acid accumulates and turns to crystals in the joints. Gout occurs most commonly in the big toe because uric acid is sensitive to temperature changes. At cooler temperatures, uric acid turns into crystals. Since the toe is the part of the body that is farthest from the heart, it's also the coolest part of the body, and thus, the most likely target of gout. Gout, however can affect any joint in the body.
Genetics also play a role in the tendency to accumulate uric acid. Other factors that put a person at risk for developing gout may include high blood pressure, diabetes, obesity, surgery, chemotherapy, stress, and certain medications such as diuretics (water pills) and vitamins. While gout is more common in men aged 40 to 60 years, it can occur in younger men as well as in women.
Gout presents with intense pain that comes on suddenly -- often in the middle of the night or getting up in the morning. There may also be other signs of inflammation such as redness, swelling, and warmth over the joint. There may be difficulty walking or standing due to the pain.
To diagnose gout, the podiatrist will ask questions about your personal and family medical history and your diet, followed by an examination of the affected joint. Laboratory tests (uric acid level) and x-rays may also be ordered.
The initial treatment of an attack of gout typically includes:
Medications: Prescription medications or injections are used to treat the pain, swelling, and inflammation; the podiatrist may prescribe an anti-inflammatory and or medications to help lower the uric acid level.
Dietary restrictions: Foods and beverages that are high in purines should be avoided, since purines are converted in the body to uric acid. Persons prone to gouty attacks should avoid purine-rich foods such as shellfish (shrimp, crab, lobster, conch, etc.), organ meats (kidney, liver, etc.), red meat, processed meats and cheese, red wine and beer.
Cherries: Recent studies have shown that people with gout may be able to cut their risk of recurrent attacks in half by eating about one cup or 20 cherries a day. The report states cherries help keep the inflammation in check and may reduce the uric acid levels and inflammation in the body. Researchers credit anthocyanins -- antioxidant pigments found in red and purplish fruits and vegetables, including cherries for the beneficial effect. These antioxidants stabilize unstable molecules called free radicals, which cause inflammation and damage cells and tissue. More studies are being done in this area. Black cherry extract tablets can also be taken if you cannot find fresh cherries.
Fluids: Drink lots of water daily to help flush out the uric acid; avoid alcoholic beverages. Coffee and other caffeinated beverages act as a diuretic, (causes you to urinate a lot) which can cause more dehydration.
Immobilize and elevate the foot: Rest your affected foot by avoiding long standing and walking. Also, elevate your foot (level with or slightly above the heart) to help reduce swelling. Sometimes the podiatrist may put a bandage on the foot to help with the pain and swelling.
The symptoms of gout and the inflammatory process will usually resolve in three to 10 days with treatment. If gout symptoms continue, regardless of your initial home treatment, see a podiatrist. If repeated attacks occur, you may need long-term treatment that will mean daily medications to control the uric acid level. It is important to treat and resolve the gout, because repeated episodes of gout can damage the joint permanently and cause arthritis.
o For more information email us at foothealth242@hotmail.com or visit www.apma.org. To see a podiatrist visit Bahamas Foot Centre, Rosetta Street, telephone 325-2996 or visit Bahamas Surgical Associates, Albury Lane, telephone 394-5820 for an appointment.
Click here to read more at The Nassau Guardian
