GOUT
Gout is a metabolic disease that attacks the joints of the body. The body’s chemistry produces uric acid. If levels of this become too high (over 7 milligrams/deciliter), there is a risk that the uric acid will form crystals in the joint fluid. This is extremely irritating and painful. The joint will become red, swollen and exquisitely painful to the slightest touch.
The initial attack of gouty arthritis will usually be to one joint, most often the big toe. Recurrent episodes of gout are likely if no treatment is given and a chronic state of multiple joints being affected is possible. Triggers of gout attacks include trauma, alcohol consumption, infection, surgery, radiation, medications, and dietary influences. Other inflammatory joint conditions that mimic gout include pseudogout, osteoarthritis, rheumatoid arthritis, infection and other rarer conditions. The diagnosis of gout is made by aspirating joint fluid with a needle and finding urate crystals in the fluid. X-rays of an afflicted joint will usually be normal other than soft tissue swelling.
Gout is most common in men over age 25 and in postmenopausal women.
In addition to the big toe, other joints likely to be affected include the forefoot, ankle, knee, wrist, fingers and elbow. Attacks usually resolve in 10 days without treatment. Chronic gout will cause constant achy pain in the afflicted joints and tophi may appear under the skin. The tophi are collections of the urate crystals.
Treatment of an acute attack will use a variety of drugs. Colchicine is effective but will often cause diarrhea. Non-steroidal anti-inflammatory drugs are very helpful. Corticosteroids by mouth or injection into the joint are effective also.
Prevention is necessary in cases of chronic gout. Purines are proteins in food that can be turned into uric acid in the body. Avoiding high purine foods such as red meat and shellfish will help lower uric acid levels somewhat. Eliminating alcohol is often necessary to control attacks. People with gout can be either overproducers of uric acid or underexcretors. A 24 hour urine collection to measure uric acid can help determine this. Two classes of drugs can lower uric acid in the blood. A uricosuric drug will help the kidneys to excrete more uric acid. A xanthine oxidase inhibitor drug will block production of uric acid. These drugs need to be taken daily to prevent elevations in uric acid and subsequent gout attacks.
Alternative therapies for gout are few and include nutritional supplements, cherries, bromelain, fish oil and certain vitamins.
Daniel Blodgett MD