Re: Big Toe

March 1, 2004

Here you go, Patti - if it sounds like you, you may want to get it

checked out. Hope this helps!

Love Lana

Gout is one of the most common forms of arthritis (joint

inflammation). It appears as an acute attack often coming on

overnight. Within 12-24 hours there is severe pain and swelling in

the affected joint. The skin over the joint may be red and shiny.

Gout usually affects only one or two joints at a time - most often

the feet and ankles. The ball of the big toe is the commonest site.

Without treatment the attack subsides in a week or so and when

patients first develop gout there may be intervals of many months or

even years between attacks. As time goes by, these tend to become

more frequent and more severe and eventually many joints may be

involved, sometimes all at the same time. At this stage a state of

chronic or continuous joint disease may develop with progressive

joint damage, disability and crippling (chronic gout). Gout affects

mostly men and is very rare in women until after the menopause when

it is quite often seen. Gout is very common in New Zealand and it is

particularly common in Maoris and Pacific Islanders. Some surveys

have shown it to be present in up to 10% of adult males.

What causes Gout?

Uric acid is a chemical which is a natural part of the normal

breaking down and building up of food and body tissues. The level in

the blood can be measured and shows how much there is in the body

overall. The condition of raised blood uric acid is called

hyperuricaemia. When this is present the uric acid which is normally

dissolved in the blood may, from time to time, form microscopic

crystals in the joint. These crystals set up the inflammation which

is called acute gouty arthritis or acute gout.

It follows that gout may develop in persons whose uric acid is higher

than normal. There are many causes of this. The following are some of

the more common causes:

Higher than normal levels of uric acid can be part of the inherited

make-up of some families

Obesity

High alcohol intake

High intake of food containing purines (see below)

Some of the drugs used to treat high blood pressure.

Less commonly, longstanding kidney disease may result in high blood

levels of uric acid.

Treatment of Gout

The first step wherever possible must be to correct those factors

mentioned above which give rise to high uric acid levels. Purines are

substances found in food, which, when broken down produce a lot of

uric acid. Therefore the following foods which are high in Purines

should be restricted or avoided:

Offal foods such as liver, kidneys, tripe, sweetbreads and tongue.

Excessive amounts of red meat.

Shellfish, fish roe and scallops.

Peas. lentils and beans.

Alcohol intake should be reduced. Two glasses of beer a day or less

is sensible. On special occasions you can drink more.

Weight loss may be very important.

Medication for high blood pressure may need to be altered.

Treating the Acute Attack

One or other of the anti-inflammatory drugs (NSAIDs) can be very

effective but to gain the best results the dose should be adequate

and the drug taken as soon as possible at the first sign of an

attack. Hence medical advice must be sought early. With effective

treatment the attack may be controlled within 12-24 hours and

treatment need not be continued after a few days. Rest and elevation

of the part involved and a fluid intake increased by an extra 4 or 5

glasses of water a day are also important. Drugs used for the acute

attack have no effect on reducing uric acid levels.

How to Lower Uric Acid (Hyperuricaemia)

If in spite of all the measures above the uric acid remains high and

attacks continue or become more frequent, other drugs can be used

which directly lower the blood uric acid. However, it must be

understood that these drugs have no effect on the actual attacks of

acute gout and they must be taken on a continuous and long term

basis. The dose must be adjusted by repeated checks on the blood uric

acid before a permanent maintenance dose can be decided on. Once the

uric acid is down within normal limits, the patient should remain

free from gout provided the drug is continued. Some drugs work by

increasing elimination via the kidneys and others by blocking uric

acid formation.

It is also very important for patients beginning such drugs to

realize that for the first few months of treatment, gouty attacks can

become more severe and frequent. This is usually controlled by taking

one or two tablets a day of an additional drug for at least several

months and if any acute attacks do appear they must be treated in the

usual way and the long term medicines continued.

Complications of Gout

Where high uric acid has been present for a long time and acute gout

has been frequent and severe, deposits of uric acid salts may appear

around the affected joint and even in tissues elsewhere such as the

ears. These are seen as chalk coloured nodules called tophi. Their

presence indicates the need for treatment with one or other of the

long term uric acid lowering drugs mentioned above.

High uric acid levels and recurrent gout are often associated with

high blood pressure which your doctor will check and treat as

necessary. This combination of hyperuricaemia and high blood pressure

can lead to kidney damage so it is all the more important, not just

because of the effects on the joints, to correct this state of

affairs through the proper use of all the measures mentioned above

under your doctor's supervision.

Unproven Remedies

The promises of quick " cures " and " miraculous relief' sound wonderful

to a person with a chronic illness. Most of the products advertised

in this way whether drugs, dietary supplements or mechanical devices

are not harmful but worthless and expensive. To avoid falling into

these traps people should discuss with their doctor any other forms

of treatment they are considering.

Gout hurts so much that you will need your doctor's help to get rid

of it. The most usual place to get gout is in your big toe and that's

not funny even if your friends do laugh! Pain in other joints

especially in your feet and ankles can be caused by gout too.

Gout is very common in Maori and Pacific Islanders and men seem to

get it more than women. Some of your families may also have pain

caused by gout and it is possible that your parents or grandparents

had it too. You can't change these things just as you can't cure gout

but you can avoid having more bad attacks of this very painful

condition.

You Can Help Yourself Get Rid of the Pain

Here are a few tips to help you:

Your doctor will give you pills to take.

Take them every day.

If you think the pills make you feel worse talk to the doctor about

changing the tablets but DONT STOP TAKING THEM.

Try to keep your weight down.

Ask your doctor or health worker to give you good advice about diets

that will help you do this.

Some foods will make your Gout much more painful. Try to cut down or

avoid:

Red meats which come from cows or sheep and include steak, chops,

corned beef and larger pieces of meat usually roasted in the oven.

Brains, kidneys, liver & heart (offal).

Shelifish such as pauas, pipis, mussels, oysters and sea eggs.

Peas and beans.

Alcohol. especially beer and wine.

The pain caused by Gout will go away. If you are careful you can

avoid having more bad attacks of Gout.

March 1, 2004