What Ails You: A closer look at gout

Last week we talked briefly about three common forms of arthritis: gout, osteoarthritis and rheumatoid arthritis. This week, let's take a closer look at gout. Gout used to be called "the disease of kings." Picture the corpulent Henry VII pained on his throne, his big toe wrapped in a poultice covered by rags. Gout was associated with the overindulgent life of the wealthy, who could afford rich food and drink at every meal.

Certainly diet is associated with gout, but not as proof of gluttony. Instead, gout is associated with a metabolic imbalance. Either your body produces too much uric acid or it doesn't eliminate enough.

Approximately two million Americans suffer with gout, which is arguably the most painful arthritis. It can affect anyone at any age, but it affects men nine times more often than women. Your first attack will likely occur between the ages of 40 and 50. Women won't normally develop gout until after menopause.

Gout comes on suddenly and has nothing to do with overexertion. You went to bed last night feeling just fine, but during the night you woke with severe, throbbing pain probably in your big toe, but it could affect other joints. The shoulders, hips and spine are rarely affected by gout; it normally strikes in the smaller joints of the foot, ankle, wrist or hand. There is a very similar condition - pseudogout - which normally affects the knee. The joint is tender and warm to touch. It is red and probably swollen. The slightest twitch in the joint and you're reeling from the pain which might feel like someone is twisting a knife in the joint.

The severity and sudden onset of the pain will probably send you hobbling immediately to the doctor, but some really determined folk will decide to "ride it out." A gout attack will normally resolve in 5-10 days, finally going almost as quickly as it came on. Gout is an ongoing metabolic imbalance that left untreated will leave you prone to more frequent attacks and, eventually, damage the joints.

Proper diagnosis is imperative. Fluid will be drawn from your painful joint and examined for the presence of crystals. These microscopic crystals are causing your pain. Imagine finely ground glass inside your joint. Ouch! With gout, the crystals are excess uric acid; with pseudogout the crystals are calcium, which can eventually lead to the calcification of the cartilage in your joint. Blood tests are less useful for diagnosis. Your blood uric acid level may be normal or even low while you are in the throws of an attack. On the other hand, some folks who have never had a gout attack may have very high levels.

Gout seems to run in families and is strongly associated with obesity, diabetes, high cholesterol and high blood pressure. Heavy use of alcohol can bring on the condition as can abnormal kidney function. Certain medications can cause gout, so, if you are having an attack, it is imperative that you doctor review your regular prescriptions to rule out your meds as the culprit. Thyroid conditions seem to contribute to gout. Fever and dehydration as well as recent surgery or injury to the joint can also precipitate an attack.

To treat your immediate condition, the doctor may prescribe prescription NSAIDs (anti-inflammatory medication) or even steroids. You may have to take some longer term medications like probenecid, which helps the kidneys eliminate uric acid, allopurinol, which blocks the production of uric acid, and colchicine, which is specifically made to treat gout.

Medications can help, but it is imperative that you modify your diet to reduce the amount of uric acid that accumulates in your system. Your doctor will give you specific guidelines, but generally you will want to avoid organ meats, concentrated meat "juices" like gravy, legumes like dried beans and peas. You'll need to avoid certain vegetables like mushrooms, spinach, asparagus and cauliflower as well as legumes (dried beans and peas). The yeast in beer will aggravate your condition; it's best to avoid all alcohol.

Other foods may actually help. Berries may lower uric acid. Certain nuts may help reduce inflammation. The fatty acids in salmon, flax seed and olive oil may also help reduce inflammation.

Gout is not normally a one-time event. If you have had one attack, you are vulnerable to more. Make the lifestyle changes you need to and take your medication regularly. Taking care of yourself will minimize your risk for future attacks.

ABOUT THE WRITER:
Jackie Randa is a physical therapist who owns Back on Track in Barstow. She can be contacted at jranda@aol.com