The Season for Acute Gouty Attacks has Arrived in Florida

As cooler temperatures have arrived at Central Florida Foot & Ankle Specialists the first cases of 'Acute Gouty Attack' are arriving in my waiting room. These patients are easily identified by their obviously painful gait, 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 do 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 patients intake of foods that break down into purines (the precursor of uric acid) is also helpful. Avoiding shell fish, which I find to be most frequently the culprit, is recommended. Dr. Vic McNamara