by Estela Dela Fuente

Created on: April 24, 2008   Last Updated: April 29, 2008

One morning you swing your legs out of bed and take the first step toward the bathroom. An excruciating pain in your big toe forces you to sit back on the bed. You examine your foot while wracking your brain for possible causes of the red, swollen joint. You don't remember having stubbed your toe, didn't drop anything on your foot, didn't kick a football the wrong way, didn't wear new shoes recently. So what is it? Very likely, it is metabolic arthritis, the new name for gout. Gout is caused by the deposition of uric acid crystals in cartilage, tendons, and surrounding tissue. When foods rich in certain proteins are broken down in digestion, a chemical called uric acid is formed and released into the blood. For reasons not clearly understood, the uric acid level may reach high levels in the blood stream and the acid comes out of the blood stream and forms crystals in the joints. Mostly this happens in the big toe, but the crystals can form in other joints, like elbows and knees.

In earlier times when most people could not afford much meat, gout was thought of as a rich man's disease. King Henry VIII, with his love of rich food and copious amounts of wine and mead, personifies the image of the gouty rich.

Now that protein-rich diets are more common, more people are finding themselves temporarily crippled by excruciating pain that begins suddenly. The affected joint will also be swollen, warm, and tender to the touch. If the gout is in the feet, it may be impossible to wear anything other than soft slippers. Recall the Mother Goose rhyme: "Lazy Tom, with jacket blue, stole his father's gouty shoe; the worst of harm we can wish him, is, his gouty shoe may fit him.

The disease strikes primarily men in their 40's and 50's, and black men are more susceptible than whites. Men and women of all ages who are obese, or have diabetes, hypertension, or kidney disease are at a greater risk of metabolic arthritis.

Treatment

Non-steroidal anti-inflammatory drugs such as ibuprofen are the medication of choice for treatment of the pain and swelling that mark an attack of metabolic arthritis. Keeping fully hydrated by drinking plenty of water is also beneficial because the water helps to dissolve the uric acid crystals and wash them out of the affected joint. Some sufferers benefit from application of ice packs for 30 minutes at a time, whereas others find that wet heat works better for them. Elevating the painful joint above the level of the heart helps reduce the swelling.

Prevention

The first attack of gout should be referred to a doctor to determine whether it results from a metabolic impairment, or whether it is the result of some other condition, such as kidney failure. If the gout is of metabolic origin, changes to the diet may help prevent future attacks. Patients are told to reduce their consumption of protein, especially seafood and organ meats such as livers, gizzards, brains, and kidneys. Alcohol may exacerbate the production of uric acid, although red wine in moderate amounts may act as a preventive. Drinking plenty of water and never letting oneself get dehydrated during exercise will help stave off the elevation of uric acid in the bloodstream. Some studies indicate that dairy products such as milk and cheese help to prevent the formation of uric acid crystals.

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