Gout refers to the buildup of uric acid crystals within a joint. Uric acid is typically broken down in the body and excreted through the kidneys. Gout is most commonly seen in the big toe joint within the foot, though it can occur in any joint. Symptoms typically include a sudden onset red, hot and swollen joint with severe pain. Often times when Gout first arises, the joint is extremely painful to move. Usually the worst of the pain is the worst in the first few days, then proceeds to subside. Due to the overall appearance and level of pain, Gout can sometimes be confused with an infection. Luckily, Gout is not an external infectious process, but rather an internal issue. Typically, an excess of uric acid means you either under excrete it (don't get rid of it fast enough), or over produce it. The most common is the former (not getting rid of the uric acid fast enough). As a result, the uric acid accumulates in a joint and over time crystallizes within that joint. These crystals are often sharp, and collect to form groups (Gouty tophi). The Gouty tophi take up space which causes pain/discomfort and will actually eat away at the joint over time.
Treatment begins conservatively, with laboratory tests, injects, diet modifications, and medication, to name a few. If first line treatments are unsuccessful, then we can perform a joint aspiration (which means taking a sample of the joint through a needle, you will be numbed first). We work closely with primary care physicians and specialists to ensure a team based approach for maximum patient safety. In some rare cases, surgical intervention might be necessary.
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