Gout and Pseudogout
This series of educational material is a broad overview of foot problems, and not as detailed as an actual podiatrist visit. I recommend you to see a podiatrist for professional evaluation of your foot and ankle problems. This is for educational purposes only.
This material is from my own experiences seeing patients. Other podiatrists may have different recommendations. Each examination has nuances and details too small to mention in this type of presentation.
What is Gout & Pseudogout?
A good source of information and to find gout doctor near you: https://gouteducation.org/. This website is not associated with A Foot Doctor.
Gout and pseudogout are very similar. An in-person visit to a podiatrist or other physician is important for proper diagnosis. X-rays, blood tests, and even joint fluid testing may be necessary to find the best treatment for you. Because gout and pseudogout are systemic diseases, a podiatrist is not your best option for long term treatment.
Gout is the condition where a person has too much uric acid in their body. Uric acid crystalizes like salt, usually in the big toe joint, and causes a lot of pain. It is important to keep in mind that gout is not just limited to the joint that is painful. The whole body has excess uric acid and the whole body is affected.
The official name for pseudogout is calcium pyrophosphate deposition disease. As the name suggests, it is a disease that deposits extra calcium in and around joints and cartilage.
A podiatrist can help your feet feel better. A rheumatologist (arthritis or joint doctor) can help your whole body. A nephrologist (kidney doctor) may also be needed if someone has kidney dysfunction.
Causes
Gout is caused by too much uric acid in the body. The extra uric acid crystallizes and causes pain. But why does the body get excess uric acid? There are many possible causes. Genetics, diuretics (water pills), alcohol, soda, high blood pressure, immune system suppressing drugs, kidney problems, obesity, diet, and more.
Pseudogout is less understood than gout. The causes are not as well known. Some possible causes of pseudogout are; genetics, underactive thyroid, overactive parathyroid, excessive blood iron and calcium levels, low magnesium levels, joint trauma, and increased age.
Symptoms
Gout most commonly occurs at the big toe joint. It can also flare up in the ankle, knee, fingers, wrist, elbow, and ear.
- A sudden red, swollen, burning, painful joint that hurts with even a bedsheet rubbing on it.
Pseudogout flare ups can be sudden or build up over 2-3 days.
- Over years it can cause hard bumps that stick out from the skin.
- Over many years it can destroy bone and joint surfaces causing lots of pain and destroying the joint.
Treatment
Gout and pseudogout are best treated long term by a rheumatologist or family medicine physician familiar with gout. A podiatrist can assist you with flare ups in the foot or with surgery to fuse a joint destroyed by gout. Very few podiatrists can or will treat gout systemically.
The first gout treatment is prevention. Avoid or limit foods high in purines. This part does not apply to pseudogout.
- Alcohol, beer, hard liquor, wine.
- Meats: liver, sweetbread, kidney, brain, tongue, bacon, pork, beef, lamb.
- Fish and seafoods: herring, anchovies, shellfish, sardines, tuna, scallops.
Non medication treatment options for gout (not pseudogout). There are some studies and a lot of anecdotal stories about the effectiveness of tart cherry and black cherries in decreasing the occurrence of gout flares. You can take extract capsules, drink tart cherry juice, or eat the entire cherry. For cost and ease extract capsules are the easiest option. Eating 30-40 cherries a day may be tough and drinking 1-2 cups of cherry juice a day will get old.
Disclaimer: speak with your medical professional to be safe and to find the best treatment plan for you.
- There is no consensus on the exact cherry extract capsule size to take.
- Most capsule sizes range from 500mg – 3600mg.
- If you want to try it out, you can start at 1200mg a day for 6 months, if no improvement is noticed then move up to 3600mg a day for another 6 months. If still no improvement I would just give it up and look elsewhere.
- A single 500-1000mg Vitamin C supplement daily may help decrease gout attacks. This can be good to take even if you don’t have gout.
The next treatment is medication to calm down flare ups. These help with both gout and pseudogout.
- NSAIDs
- Colchicine – this can only be obtained with a prescription. Take a single tablet followed by a second tablet 1 or 2 hours later. There is slight variation in how each physician likes to write the prescription but the end results are the same.
- Corticosteroids – injection or prescription. You can only get these from podiatrist or other physician.
Systemic treatment is important for gout that flares up multiple times a year
- Your best option is to find a rheumatologist or family medicine physician that is familiar with managing gout.
Surgical treatment may be necessary if a joint has undergone years of gout and pseudogout flares. There are 3 types of surgery.
- Opening and cleaning the joint of crystals.
- Replacing the damaged joint surfaces with an implant or implants.
- Fusing a joint that has been damaged beyond repair.
