“The best medicine I know for rheumatism is to thank the Lord that it ain't gout!” ' Josh Billings '
I recently ran into an old friend of mine. As we did the standard “Hi, hello, how are you?” exchange, he suddenly said, “Oh, I totally forgot you were a bone doctor! I should’ve called you last week because my Dad had terrible pain in his foot and he felt he was being haunted by the devil!” (Hmmm. Maybe they should have called an exorcist, I thought). Turns out they went to a hospital ER, were seen by an ER physician who gave them a request for uric acid test. And then he popped the question: “Is gout the same as arthritis?”
This is indeed, a valid and logical question, especially if you’re not an orthopedic or joint specialist. Even General Practitioners cannot differentiate the two. In fact, it is not uncommon that patients come into my clinic with pain in their foot and has a uric acid test already with him (often times with normal results), as ordered by his GP.
What is gout and what causes it?
First it is important to note that there are different types of arthritis, hundreds in fact. Gout arthritis and osteoarthritis (most laymen call osteoarthritis simply as arthritis), are just 2 of the more common types, especially in Filipinos.
To put it simply, gout is a version of arthritis caused by too much uric acid in the blood stream. Here, the body either makes too much uric acid or it cannot excrete it from the body through the kidneys in large enough quantities. If you think about a tub and a water spout, if the drain on the tub is open, you can turn the water on full blast, and the tub won't overflow. Same thing with the body and gout. If your body gets rid of uric acid properly through your kidneys, you don't have to completely avoid those bad but yummy stuffs rich in uric acid (More on this later.)
What are the symptoms of gout?
The most common clinical feature of gout is a sudden, severe attack of throbbing pain, tenderness, redness, warmth, and swelling in some joints, with a feeling like the world hates me (or as the father of my friend mentioned, “The devil is haunting me!”). Even a light touch can elicit severe pain. Gout is more likely if arthritis first appears in the big toe but it can also affect other joints in the leg -- such as the knee, ankle, and foot -- and, less often, joints in the arm including the hand, wrist, fingers, and elbow. Spine is very rarely involved.
The speed of the onset of pain and swelling is important for the diagnosis. Symptoms that take days or weeks (rather than hours) to develop probably indicate a disorder other than gout.
How does too much uric acid cause the painful arthritis attack?
Everyone has uric acid in the blood, and that comes from the daily turnover of cells in the body. However, it’s only when the levels reach too high proportions that uric acid crystallizes and may find their way into joints. These uric acid deposits may initiate an inflammatory reaction (pain, swelling) due to the body producing white blood cells to combat the uric acid intruder. When this happens the inflamed area also produces heat and thus, becomes warm.
Over time, these uric acid crystals may also form into gritty nodules called "tophi." These nodules can appear as lumps under the skin near joints such as the elbows and fingers, at the rim of the ears, even in the kidneys.
Are there certain foods to avoid in gout?
There are certain diet restrictions to follow if the individual has gout, or is predisposed to this disease.
1. Alcohol, especially beer
3. Organ meats such as liver and kidney
4. Sardines and anchovies
6. In the bean family, avoid lima beans and kidney beans
So how do we differentiate gout from osteoarthritis?
To make things simple, below is a link to a table showing the difference between the common clinical features of gout and osteoarthritis
What is the best way to diagnose gout arthritis?
Blood levels of uric acid will give you an idea if you have gout or not. But a synovial fluid examination is the most accurate method for diagnosing gout. Your doctor will use a needle attached to a syringe to draw out fluid from the affected joint. This is called aspiration. The procedure is usually only mildly uncomfortable. (Parang kagat lang. Kagat ng buwaya!) Afterwards, there can be some minor discomfort in the area where the needle was inserted, but it usually goes away in no time.
The fluid sample is sent to a laboratory for analysis. Presence of monosodium urate (MSU) crystals, nearly always confirm a diagnosis of gout. The laboratory can also test the sample for infection.
So, dear readers, just to clarify. If your foot is not suddenly red, very swollen and/or exquisitely painful, it’s probably not gout. If your pain is vague and generalized, it’s probably not gout. If you don’t have accompanying general feeling of malaise, weakness or mild fever, it’s probably not gout.
If, however, you think it may in fact be gout, be sure to see your bone doctor and immediately discuss treatment options so the best course of treatment for you can be decided.
P.S. There is a condition known as pseudogout. Its presentation is very much like gout but the underlying cause is different. More on this on the next blog post…