Q: My son-in-law thought he just did something to his toe. I thought it reminded me of gout, since his toe is swollen and he has a lot of pain. What is good to do for gout?
A: To begin with, your son-in-law needs to see his physician to confirm the diagnosis which can likely be made through a visual examination and brief history of events and possibly lab testing. There is no point in him taking steps to treat the condition if there is any question at all.
Gout is a form of arthritis that presents with sudden, severe pain and redness of a joint. The condition commonly occurs in the great toe but it can also be found in the ankles, feet, hands and wrists. The condition is seen more in men than in women but anyone can get it. It occurs when a person has high levels of uric acid in the blood. The body naturally produces uric acid when it breaks down purines. An excess of uric acid can also be found when a person ingests specific foods including asparagus, herring, organ meats, anchovies and mushrooms. In healthy individual, uric acid dissolves in the blood, passes through the kidneys and is expelled with urine. However, when the body produces too much uric acid or the kidneys fail to excrete sufficient uric acid, needle-like urate crystals can form in a joint or in surrounding tissues. The result is redness, pain, and inflammation.
So, what causes gout in one person and not in another? Well, there are a number of things to consider. First is the consumption of an excessive amount of alcohol. As a general rule, more than two drinks for men and more than one for women increase the risk of developing gout. Thiazide diuretics prescribed to treat hypertension and low-dose aspirin can be to blame. Medical conditions that include diabetes, arteriosclerosis, hypercholesterolemia and high blood pressure are linked with gout, as is a family history of the disorder. Dietary choices that include the food items mentioned above also increase a person’s risk for developing the condition. Lastly, age and sex have a bearing. Men develop gout earlier (at around 40 or 50 years of age), than do women who may never get gout or who may not have any symptoms until after menopause.
Other than through a visual exam, diagnosis can be made with the help of a blood test. I must state, however, that a blood test is not always confirmatory. Some people may have signs and symptoms without abnormal levels of uric acid in their blood. Others may have higher than normal levels but not experience gout. This is where the expertise of a physician comes in.
Treatment is commonly provided with medication (to lower inflammation)such as NSAIDS (non-steroidal anti-inflammatory drugs), colchicine for those who cannot take NSAIDS, and steroids. Repeat attacks may be managed more aggressively with xanthine oxidase inhibitors such as allopurinol that block the production of uric acid in the body. A new drug Uloric may be considered as well, or probenecid that helps eliminate uric acid from the kidneys.
On the home front, alcohol should be avoided or consumed in moderation; at least eight cups of fluids such as water should be consumed daily; meats, fish and poultry should be kept to between four and six ounces daily; and protein intake in general should be moderate. And here’s where we step outside the box. Alternative approaches for prevention that have been studied for lowering uric acid levels include coffee and dark fruits such as cherries. Coffee – whether with caffeine or without, may lower uric acid levels, as will the cherries mentioned above, blackberries and purple grapes that can be consumed dried, fresh, or canned depending on the fruit choice as a preventive and also during an attack.
Have your son-in-law visit his physician to confirm your suspicions. If you are correct, he can then ask the opinion of his physician as to which treatment might work best for him.
Other readers who would like related information can order Dr. Gott’s Health Report “About Gout” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.
