As central Florida experiences cooler temperatures, we are receiving cases of so-called “acute gouty attack” in our clinic. These patients are easily identified by their obviously painful gait and red, hot and swollen joints of the foot. The patients will describe having had no trauma and going to bed without pain or symptoms, only to awake in the wee hours of the morning in significant pain.
This is due to the cooler temperatures and lower intra-joint pressures of the foot allowing the precipitation of uric acid crystals into the joint. White blood cells then attack these perceived foreign bodies in an attempt to dissolve them with their potent enzymes. Unfortunately, they are not up to the task, and they die, thereby spreading their inflammation, causing enzymes throughout the affected joint.
Most patients improve quickly with a taper-down dosing of Indocin, but the reason for the attack, a high blood-uric-acid level, must be dealt with to prevent recurrence of symptoms and eventual joint destruction. This intervention usually takes the form of medication to improve the kidneys’ capacity to excrete uric acid more efficiently. Reducing the patient’s intake of foods that break down into purines (the precursor of uric acid) is also helpful. Avoiding shellfish, which we find to be most frequently the culprit, is recommended.