FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

READER'S GOUT A FORM OF ARTHRITIS THAT CAN BE TREATED

Question: My doctor tells me my foot became very sore because I have developed gout. What is gout and what causes it?

Answer: Gout is actually a form of arthritis. In fact, it is the third or fourth most common arthritic disorder, depending on who is doing the counting. Gout is much more common in men than in women and affects middle-aged persons most frequently. Unlike many arthritic conditions, we have clearly identified the cause and have several treatments which are usually effective.

Gout is caused by excessive amounts of uric acid in the blood. Some of this uric acid eventually "settles" around a joint by forming crystals that cause inflammation. The use of the singular word "joint" is not accidental, since gout differs from other types of arthritis in that it usually attacks only one joint at a time. Most often, it's a joint in the big toe that's affected. An attack usually begins suddenly, reaches its peak in less than 24 hours, and then disappears even without treatment in two weeks or less.

Foods and beverages high in chemicals called purines should be avoided by people prone to gout, because large amounts of these foods may bring on an attack. Some examples of high-purine foods are red meats, organ meats like liver and kidney, and wild game. These chemicals are also found in alcoholic beverages, particularly beer and wine.

Gout, like several other forms of arthritis, is considered to be hereditary. That is, it occurs more often in people who have blood relatives with the disease.

Question: My doctor prescribed Zyloprim for my gout. Is this the standard treatment, or could the problem be controlled by just changing my diet?

Answer: Gout can't usually be controlled by diet alone. To understand why, it's necessary to know a little more about how gout develops. As I said earlier, the person with gout has excess uric acid in his or her blood. However, this can happen in two different ways. The body can either produce too much uric acid, or the kidneys may be unable to eliminate uric acid at the normal rate. The end result the excess uric acid in the blood that then accumulates as crystals in the joint is the same in both cases, but each requires a different treatment.

Gout can be controlled with medication. There are several different drugs that can help. Some medicines decrease swelling and inflammation of the involved joint. These are used during an attack of gout. Ibuprofen and Indocin are examples of commonly used medications in this group. Others, like the Zyloprim you take, interfere with the way your body forms uric acid; and still others encourage the kidneys to eliminate increased amounts of uric acid. These last two types of medication are not effective at relieving the symptoms of an attack of gout but are used to prevent future attacks.

Once the level of uric acid has been lowered to a normal level by medications and diet, relief is not far away. After an additional six to 12 months, the frequency and severity of attacks is usually reduced dramatically. This will prevent the disfiguring and crippling joint destruction gout can produce as well as kidney stones formed from uric acid and other negative health consequences of untreated gout.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.