Treatment for gout

Dear Reader,

In the past, gout was thought to be the burden of kings and other wealthy men who could afford to live lives of gastric indulgence — stuffing themselves with fatty foods until they had swollen bellies and swollen, aching joints. Now we know that gout is a type of arthritis, and that diet plays only a partial role in its development. Gout typically affects men between the ages of 40 and 50 years. Women are less likely to get it and, if they do develop gout, it's more common among menopausal women. Gout attacks almost always come about abruptly, with no advanced notice. A person's joints (most often in the big toes, but can also be those in ankles, knees, feet, heels, hands, wrists, or elbows) suddenly become swollen, red, and incredibly tender. The pain and inflammation usually last for 5 to 10 days, and then slowly diminish, until the joints look and feel normal.

Painful gout attacks are caused by high amounts of uric acid that is made from the breakdown of purines (substances found in particular foods and in our bodies). Uric acid is usually filtered from the blood by the kidneys, then excreted in urine. When uric acid accumulates in the body (from taking in either too many foods containing purines or foods highly concentrated in it, not passing enough of it into the urine, or producing too much of it in the body as a result of a particular medical condition), it forms tiny, jagged crystals that are deposited into joint spaces. The result — imagine walking with glass fragments in your joints — is gout.

Gout is often confused with other forms of arthritis but has two key differences: (1) Gout usually attacks suddenly and severely (often overnight) instead of gradually worsening; and (2) gout typically affects only one joint (e.g., the big toe) instead of multiple joints (such as all of the knuckles of both hands). Health care providers, such as rheumatologists, can diagnose gout by a variety of ways, including blood tests, urine tests, and, occasionally, by removing a small amount of fluid from the affected joint with a needle and examining the sample under a microscope for the presence of uric acid crystals.

Gout is most often treated with high doses of nonsteroidal anti-inflammatory drugs (NSAIDS), such as indomethacin or naproxen sodium, or with corticosteroid injections in the affected joints. When these drugs are not effective, colchicine (another gout medicine) can be used — it usually isn't a first choice because it can cause nausea, vomiting, and diarrhea. Drugs that increase the amount of uric acid excreted by the kidneys may also be prescribed. Whatever the regimen, treatment is essential in preventing further pain and damage to the affected joint(s).

The National Institute of Arthritis and Musculosketal and Skin Diseases recommends that people with gout who want to prevent and/or lessen the severity of future attacks should take their prescribed medicine, and:

• Stay trim: People who are overweight are more likely to have difficulty getting rid of uric acid from the body than slimmer, fitter folks.
• Avoid certain supplements and over-the-counter (OTC) medicines: Even simple, seemingly harmless OTC drugs, such as aspirin and the vitamin niacin, can make it harder for the body to excrete uric acid. Before taking any supplement or drug (prescription or OTC), make sure it's been given a thumbs-up by the gout specialists.
• Up the intake of water and cut out the alcohol: Drinking plenty of fluids (water is the best) helps the kidneys do their job at peak efficiency. Alcohol, on the other hand, while it may send you to the bathroom more often, decreases the excretion of uric acid and can worsen a bout of gout.
• Take a pass on sweetbreads, kidney pie, and other "delicacies": Be more finicky and steer clear of foods that are high in purines, including organ meats (e.g. liver, kidney, and brain or sweetbreads), dried legumes, herring, mackerel, and anchovies.

Researchers are currently working to develop better medicines to treat and prevent gout and other types of arthritis. To learn more about the progress of arthritis research and the development of new treatments, check out the Arthritis Foundation, or the National Institute of Arthritis and Musculosketetal and Skin Diseases Information Clearinghouse (NAMSIC).