足の痛みの真実とは？

There are several signs to help you recognise a gout attack: the attack occurs suddenly, often at night, during rest, with the onset of intense pain (burning, grinding sensation) in a joint. The pain is at its worst in 6 to 12 hours; Inflammatory disease affects just one joint (mono-arthritis), often in the legs, and generally in the joint at the base of the big toe. More rarely, it affects the knee or ankle. The affected joint is red, swollen, warm, large and extremely painful to the slightest touch. The skin and subcutaneous tissues are often very red and oedematous (swollen). Fever and chills may be associated.

Acute gout is characterised by inflammatory attacks, the typical form of which is involvement of the big toe of the foot, but other joint locations are possible. These are discussed in detail in a separate chapter. The attack itself usually affects a single joint, but this is not always the case in major gout sufferers. Sometimes, two or more joints may be the site of the inflammatory attack. In this case, they are often consecutive.

Acute pain, often nocturnal. This is usually the first symptom. The pain increases progressively and is often described as burning, tearing and even grinding, tearing or biting. It is often unbearable. The patient is said to have the impression of having his foot (for example) caught in a "wolf trap".

This pain is exacerbated by the slightest contact, and can lead to insomnia and impotence of the affected limb. It is often located on the inside of the joint. The signs resemble those of an acute infection, with tumour, redness, heat and exquisite pain. The surrounding skin is taut, warm, shiny and red or purplish in colour. There may be fever, tachycardia, chills and malaise. In the early hours of the morning, the attack generally subsides. Repeated attacks each night constitute a "gout attack".

Various pathologies can resemble acute gout attacks. Microcrystalline arthritis or "diffuse articular chondrocalcinosis": is based on X-rays (calcium incrustations in articular cartilage and fibrocartilage) and the appearance of crystals in the synovial fluid (short, stocky, square-tipped, with little or no birefringence under polarised light). Inflammatory rheumatism: here are the main, non-exhaustive examples.

• Fiessinger-Leroy-Reiter syndrome
• Reactive arthritis
• Enterocolopathic arthritis
• Sarcoidosis
• Behçet
• Ankylosing spondylitis
• 関節リウマチ
• Psoriasis arthritis
• Algodystrophy

Yes, this can occur in up to 50% of patients. Blood uric acid levels at the time of the inflammatory attack are not always representative of the amount of urate crystals deposited in the joints. There are patients with overt attacks of gout who have normal uric acid, and there are also patients with elevated uric acid levels who nevertheless have few symptoms. A normal uric acid level in a blood test does not exclude a diagnosis of gout.

If you experience joint inflammation or recurrent pain without any justifying blow, especially in the big toe, instep, ankle or knee. You may also want to consult your doctor if your uric acid levels are consistently elevated in blood tests, especially if they increase significantly over the years or if they are particularly high, such as 9 or more. It may also be advisable to consult your doctor if there is a family history of gout in one or more members of your family and you suffer from hyperuricaemia.

In most cases the answer is no. In the same way that high blood pressure is not usually solved by cutting down on salt in food alone. In the same way that high blood pressure is not usually solved by lowering the salt in food alone, but with daily antihypertensive medication, the gout patient also usually needs the help of drugs to be cured.

Most gout sufferers have been depositing urate in their tissues for years without knowing or noticing it, and these accumulations cannot be dissolved by diet alone (although this helps). To dissolve the crystal deposits and thus cure gout, we need to use medication that decreases purine production (allopurinol, febuxostat) or increases its elimination (uricosurics, such as benzbromarone).