By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

PAINFUL GOUT OFTEN MANAGEABLE WITH LIFESTYLE CHANGES, DRUGS

Question: I have gout. I'm 48 years old. I've had gout for about three years. The last time I had a major attack, my doctor had me on colchicines. For the last six weeks I've had severe pain in my ankles, especially at night. Is there anything else I can do for this pain? I have given up red meat and wine.

Answer: Primary gout is a common problem among middle-aged men and post menopausal women. This metabolic disorder runs in families, and is caused by high levels of uric acid in the body. These elevated uric acid levels -- called "hyperuricemia" if you want to get technical -- can be due to either overproduction or under-excretion of uric acid, or sometimes both.

The term "secondary gout," also called acquired hyperuricemia, refers to gout that is the result of another underlying condition. This includes diseases such as multiple myeloma, psoriasis, hemolytic anemia, myeloproliferative disease and certain types of cancer. Secondary gout can also be due to lead poisoning or as the result of an adverse affect of certain medications.

Your symptoms lead me to believe that you have primary gout. Risk factors for gout are obesity, diabetes, elevated blood fats (lipids), alcohol use and kidney disease.

As you are well aware, a person's first attack of gout is generally quite severe. A classic or "textbook" case is the person who experiences an abrupt onset of severe, crushing pain in a lower extremity -- usually the big toe -- that awakens him or her from sleep. The pain is so severe that weight cannot be placed on that foot. The affected joint becomes red, "shiny looking," swollen and tender. Sometimes the sufferer also has chills and fever. This acute attack is associated with such severe pain that most people seek medical care immediately. While this is typical, not all attacks affect the big toe or, even, the extremities. Almost any joint can be involved.

Management of the acute attack should be aimed at treating the pain and the inflammation. Prevention of further attacks is best tackled after the acute attack has subsided. One of the hallmarks of prevention is dietary management -- specifically the avoidance of foods containing substances called "purines" that elevate the levels of uric acid in the blood. While you mentioned avoiding red meat and wine, there are many other foods that are rich in purines. All alcoholic beverages, especially beer, are high in purines. Other high-purine foods include organ meats -- such as liver and kidneys -- and many types of seafood, as well as bacon, veal, venison and turkey.

It is also important to review the medications you are taking to see if any are known to elevate blood uric acid levels. Also, lifestyle changes -- such as weight loss and alcohol avoidance -- can often prevent attacks and eliminate the need for drugs.

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are useful treatments. Aspirin should be avoided as it may make symptoms of gout worse. Sometimes, your physician has to try several drugs or drug combinations -- in addition to your own lifestyle changes -- to make you pain and attack free. Drinking plenty of water also helps rid your system of uric acid. Even with aggressive treatment, a chronic gouty arthritis can develop. Prevention of this is the primary goal of early treatment.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.