388 Garden Ave, Suite 120 Holland, MI 49424 P: 616-393-8886 F:616-393-9975 www.northwoodfootandankle.com GOUT Gout is a common, recurrent condition of joint arthritis in which crystals of uric acid are deposited within the joints which leads to inflammation and pain. It is due to a uric acid overproduction or uric acid under excretion by the kidneys resulting in higher uric acid blood levels. More commonly seen in men than women, it most often appears in the big toe joint, but can involve any joint, spine or kidneys. If Gout is left untreated, the joints involved may be damaged and surrounding tissues may become inflamed. Kidney stones are also a possibility. Five to ten percent of the population normally has a high blood level of uric acid, called hyperuricemia, but they do not have symptoms and therefore not considered to have Gout. There are many factors that increase the risk of Gout. Some medications may cause Gout, such as diuretics like hydrochlorothiazide and furosemide, and antibiotics. Gout is more likely to appear with disorders like Leukemia, Polycythemia, Thyroid disease, Kidney disease, high blood pressure, Diabetes, high cholesterol, Anemia, Coronary Occlusive disease, and blood vessel diseases. Gout can also be caused by low dose aspirin, dehydration, sleep apnea or diets high in animal products or shellfish. Other things to consider are family history, age 50 or higher, male gender, obesity, trauma or surgery, emotional stress and chemotherapy or radiation treatments. Diet can play a role as eating certain foods can lead to a high uric acid level. SIGNS AND SYMPTOMS: *Sudden, severe joint pain (within hours), especially the big toe. Sometimes the weight of bed sheets may even be intolerable. The individual may be awakened from sleep due to sudden pain and the joint may be red, hot, and swollen. *Skin overlying the swollen joint may be tight and shiny. *Painless, firm nodules on the external cartilage of the ear, sometimes seen on the fingers, hands, feet, Achilles tendon, and under-surface of forearm can occur. This is rare and usually over time; it happens in what is known as chronic tophaceous gout. The nodules are called tophi (singular is tophus). DIAGNOSIS: Joint fluid analysis, blood levels or uric acid (which can be misleading and is not diagnostic of Gout by itself), x-rays and bone scan. TREATMENT: Gout is usually treated with 2 types of medication. The first medication is used to reduce the body’s level of uric acid. The second medication is used to reduce inflammation and pain. Cortisone injection into the joint is very effective. Oral cortisone can also be prescribed. Warm or cold compresses on affected joints. Diet-AVOID sardines, liver, kidney, sweetbreads, anchovies, shellfish, red meat, pork, bacon, meat stocks, soups, or gravies, alcohol, and asparagus. There are many other trigger foods listed on the next page. Drink lots of water to help flush out the kidneys and prevent stone formation. GENERAL DIET INFORMATION: What is it? A low purine diet means eating foods that do not have many purines in them. Purines are found in some foods listed below. Uric acid comes from the breakdown of purines. The body does not use uric acid, so it is usually filtered by the kidneys and taken out in the urine. When uric acid builds up in the body, it can cause pain and swelling known as Gout. It may also cause kidney stones. You may need to follow this low purine diet if you have these problems. Gout is often treated with medicines that help the body get rid of extra uric acid. But, eating the right foods can help limit the amount of uric acid in your body. Eat a diet that has a large amount of complex carbohydrates such as fruits and vegetables, not fruit juices or vegetable juice. Eat at least 5 fruits and/or vegetables each day. Do NOT drink alcohol as alcohol can cause Gout to flare up. Also, do not consume any drinks with high fructose corn syrup (soda pop).

388 Garden Ave, Suite 120 Holland, MI 49424 P: 616-393-8886 F:616-393-9975 www.northwoodfootandankle.com **Always choose LOW Purine foods when treating a gout flare. ** LOW PURINE FOODS AND BEVERAGES: Tea Cream-Style soups (not meat stock soups) Eggs Fresh turkey not processed Fruits and Vegetables Gelatin Healthy fats and oils (Olive or Coconut) Hard Cheeses Nuts (not peanuts, they are a legume not a nut) Pasta and macaroni Soups made without meat extract or broth Vegetables not on the lists below MEDIUM PURINE FOODS: Asparagus Beef, Lamb, Pork, and other red meats, fish, shellfish, and poultry not on the high purine list below Broth, consommé, and bouillon, or soups made with meat or poultry stock Cauliflower Dried beans, peas, lentils, peanuts, and peanut butter Fresh beans and peas Meat soups, broths, gravies Mushrooms Tomatoes and tomato sauce Oats and oatmeal Spinach Wheat germ and bran Whole grain foods Gluten Yeast: all types HIGH PURINE FOODS: Anchovies Meat broths, bouillons, gravies, and consommés/Meat extracts Caviar or Roe Game meats, like goose, duck, and partridge Some fish, like herring, anchovies and mackerel Shrimp and all shellfish, sardines, scallops and mussels Mincemeat Organ meats: brains, heart, kidney, liver, sweetbreads

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