The Pain of Gout Doesn't Need to Happen

Doctors have recognized gout since Hippocrates in ancient Greece. In the sixth century B.C., a physician from Byzantium, Alexander of Tralles, found that a laxative was effective in treating gout. That same treatment is still effective for gout today. 

Over the centuries, the belief was that only the rich got gout, those that could afford fine wines and roast beef and chicken dinners. The cartoon of the obese rich man with his foot elevated and his big toe red and swollen isn't far off. Inflammation of the big toe joint is present in over 50% of acute cases. The joint becomes red, hot, swollen, and exquisitely painful overnight. Usually the disease starts with just one joint, but it can progress to multiple joints.

Causes of Gout

Gout is caused by the disposition of uric acid crystals in the soft tissues of joints. Uric acid is a waste product from the breakdown of a chemical called purine, which is found in high concentrations in some foods. Several mechanisms can raise uric acid levels including: 

• Your kidneys may not be excreting uric acid normally.
• You may produce too much uric acid.
• Some medications can elevate uric acid levels.
• Excessive alcohol intake or a diet that contains a large amount of high purine foods can cause elevated uric acid levels.
• During chemotherapy, rapid destruction of a tumor may lead to markedly raised uric acid levels.

Treatment of Gout

There are two separate treatments. The first is for an acute attack. The second is preventive treatment after the initial episode has subsided. Treatment of acute gout includes: 

• Treatment must be based on a proven diagnosis. Infectious arthritis can present similarly, resulting in amputation or even death if not diagnosed.
• Acute treatment is primarily to reduce the pain and swelling.
• Anti-inflammatory medications and other medications are often used with good success.
• The choice of drug is usually based on the patient's health problems. Chronic gastritis would eliminate some while kidney problems would rule out others.
• Treatment for elevated uric acid levels is NOT started at the time of the first acute attack.

Treatment of Chronic Gout

Many patients never have a second attack. If repeat flares occur, the person is started on medications to lower the levels.

• Initial treatment of everyone with a gout flare consists of lifestyle changes.
• If the person is taking medications, s/he must review them with his/her doctor to see if the drugs are contributory.
• If obesity is present, diet is strongly advised with referral to a dietician.
• Avoidance of foods rich in purines is essential.
• The patient should be told to stop drinking alcohol.

Once the initial episode has resolved, maintenance therapy may be started if indicated. If started too soon, drug therapy can make the attack not only worse but also longer. The purpose of drug therapy is to decrease uric acid levels and keep them low, preventing further flares.

Gout is an extremely painful disease that is preventable. You should evaluate your diet and alcohol intake, maintain a healthy weight, and see your doctor for routine exams. Ask about gout, especially if you have a family history.