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There are some diseases and disorders of
the musculoskeletal system that, while not caused by physical activity per se, can
significantly diminish one’s athletic capacity. One such disease is gout. People
from the old school will have trouble believing that anyone afflicted with gout would be
too concerned with its effect on their athletic performance. Gout has a nasty reputation
of being exclusively a disease of obese overindulgers.
While we know that acute overindulgence and obesity are certainly risk factors for the
development of a gouty attack, many otherwise normal and healthy people can suffer from
gout.
At its roots, gout is medically known as a "crystalline arthropathy". The
origins of these two words tell the tale of the pathology of gout. Crystalline because of
mineral crystals which develop within the joint. Arthro means joint and pathy indicates a
pathological condition. So, gout is a joint disease caused by the development of crystals
within the joint.
The crystals of gout are made of uric acid. We all produce uric acid every day.
Crystals of uric acid develop within the joints or other places when one of two things
happens: 1) the body produces too much uric acid 2) the body is unable to excrete the
normal amounts of uric acid which are produced. In either case, an attack of gout is the
result.
The joint inflammation is caused when the body’s white blood cells try to injest
the crystals within the joint. Since they don’t typically "eat" uric acid
crystals and don’t know how to "digest" them, they release substances that
cause the joint to become inflammed.
The incidence of gout increases with increasing age, but gout may present in people of
virtually any adult age. The classic gout sufferer is a middle aged man.
The most common joint affected by gout is the one formed by the great toe and the foot.
Pain in this joint due to gout is known as podagra.
Aside from the joint pain that gout produces, it may also produce accumulations of uric
acid under the skin. These are know as gouty tophi (singular: tophus). Tophi do not
typically develop as a result of a single bout of gout. Rather, they form as a long term
consequence of high levels of uric acid. Tophi are not generally problematic and are
typically surgically removed only for cosmetic reasons.
In many cases, the diagnosis of gout may be made my history and physical examination
alone. X-rays are sometimes taken to rule out other causes of joint pain. Blood tests may
be performed to determine the level of uric acid in the blood. Also, depending on the
severity of disease and the joint involved, the joint fluid may be examined
microscopically to identify the crystals characteristic of gout.
Treatment of gout is a somewhat complex subject and may involve several medical
disciplines. Initially, a potent oral anti-inflammatory medication may be prescribed. For
many patients this will cure their bout of gout.
Other patients may require special medicines that either increase the excretion of gout
or decrease the production. These medicines are typically prescribed by a rheumatologist
or other specialist who is experienced in caring for recalcitrant cases of gout.
There are other crystalline arthropathies that are quite similar to gout. The most
common is pseudogout. The mechanism of pain is similar to gout. The pathological
difference between the two diseases is biochemical and largely unimportant.
The clinical manifestations differ slightly in that pseudogout typically affects larger
joints that gout. The knee and other relatively large joints are affected by pseudogout.
The diagnosis and initial treatment of pseudogout closely parallels the diagnosis and
treatment for gout. However, for people who have advanced cases, the treatment can be more
complex.
The important thing to remember is that many problems can cause pain in and around the
great toe joint or other areas. It is crucial that you have your problem addressed by a
physician who is adept at dealing with joint pathologies. Many more serious and
threatening diseases may have a similar presentation and must be ruled out.
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