If you watch TV, you may remember a commercial from last year with the middle-aged gentleman carrying around a large vial partially filled with a green liquid. The advertisement is for a new medication designed for the treatment and prevention (prophylaxis) of gout. Uloric is the first medication to be approved by the FDA for gout prophylaxis in approximately 30 years. This commercial has caused an increased awareness to many people who have had pain in their feet that may be attributed to gout.
While this particular advertisement focuses on the big toe joint, which is the most common area, gout can occur nearly anywhere in the body. I have personally seen gout attack non-joint areas such as the web spaces just above the toes. Gout is precipitated by a high amount of uric acid in the blood that will leak out of the bloodstream and typically settle in a joint. Upon settling it becomes crystallized into condensed bunches called tophi.
Acutely this will cause the affected area to be swollen, hot, red, and painful. Many patients relate that anything touching the area, even the rubbing of a sheet will cause severe pain. Chronically, long after the acute pain is gone, the gouty tophi can erode the joint surface causing arthritic pain to the area.
This type of arthritis is on the rise – particularly among men. More than 8 million people have it, and the rates have doubled in the last 50 years. Gout is no respecter of persons. It can strike anyone including famous people and professional athletes. When he wasn’t lopping off his wives’ heads, King Henry VIII of England was coping with attacks of gout. David Wells, the left-handed pitcher who played for the New York Yankees and Toronto Blue Jays has struggled with gout throughout his baseball career. Maurice Cheeks, coach of the Philadelphia 76ers and Portland Trail Blazers, who played 15 seasons in the NBA with 4 All-Star appearances, was 46 when he started experiencing severe pain secondary to gout.
How is it treated? At Tooele Medical Group Foot & Ankle Clinic we typically will treat an acute flare of gout with a cortisone injection to the area. This has been found to give the most relief the fastest. Other medications that help are non-steroidal anti-inflammatories such as IBUprofen or Indomethacin. Colchicine is another effective medication but is not prescribed as often as it commonly causes severe diarrhea. I will usually check the blood uric acid level. If it is elevated I will give the patient the option of taking a long-term medication such as Uloric or Allopurinol that will decrease the amount of uric acid in the bloodstream. Either one of these medications must be taken on a daily basis to help prevent recurrence of a gout attack as well as future arthritis. If you feel that you may have gout or have had gout in the past and would like to discuss options for treatment, please feel free to make an appointment.
Authored by: Jeff Carlson, DPM