$Unique_ID{BRK01273}
$Pretitle{Musculoskeletal System and Connective Tissue}
$Title{The Workings of Gout}
$Subject{arthritis gout causes}
$Volume{M-17}
$Log{}

Copyright (c) 1991   Tribune Media Services, Inc.


The Workings of Gout


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QUESTION:  It is time you devoted some space to your readers with gout.  This
is my problem which always strikes just when I think all is going well.  Can
you please explain the workings of this disease for me?

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ANSWER:  Gout is a form of arthritis.  It's caused by an excess of uric acid
in the body.  Everybody has some uric acid, but some people have too much.
Either they make too much or their kidneys don't flush enough uric acid out
with their urine.  As a result, the excess acid forms crystals, which tend to
collect in the joints, especially in the fingers and toes.  A gout attack
occurs when these crystals cause pain, redness and swelling in the joint.
     Generally, the first attack of gout will disappear by itself after no
more than two weeks.  Another attack may occur shortly thereafter, or it may
not happen again for years.  Left untreated, though, gout can cause
complications.  As the uric acid crystals build up in the joints, they form
tophi (or deposits).  The crystals can also lead to kidney damage and kidney
stones.  Therefore, it's important to seek medical attention for gout.
     Your doctor may check for gout via several techniques.  For example, he
or she may want to draw some fluid out of the affected joint to check for the
presence of uric acid crystals.  If that's not possible, you may be put on a
trial course of medication.  If the drug works, it rules out most causes of
your joint pain other than gout.  Finally, the level of uric acid in your
urine may be tested.  (If this is the case, for three days before the test
you'll have to limit your intake of foods high in purines, substances that
turn to uric acid in the body.)
     If a diagnosis of gout is confirmed, two types of medications can treat
the disease.  Colchicine or nonsteroidal anti-inflammatory drugs (NSAID) are
often prescribed to relieve the pain and inflammation.  These drugs will clear
up an attack of gout, however, they have no effect on future attacks.  NSAIDs
take longer to relieve gout's symptoms, but they have fewer side effects than
colchicine, which causes cramps, nausea, vomiting or diarrhea in 80 percent of
the people who take a full dose of it.
     Other drugs go to work to lower the level of uric acid in your body,
thereby preventing future attacks.  Allopurinol does this by reducing the
amount of uric acid you produce.  Probenecid and sulfinpyrazone help your
kidneys clear uric acid out of your bloodstream.  These drugs will also
dissolve any tophi you may have formed and prevent future complications such
as kidney disease.  Some doctors feel that gout patients must take drugs that
lower uric acid levels indefinitely.  However, other experts disagree.  In
mild cases, the risk of long-term use of the drugs may outweigh the risk of
future gout attacks.
     Besides taking your medication, there are a few things you can do to help
control your gout.  Keep alcohol consumption to no more than one or two drinks
a day, avoid large amounts of foods high in purine (anchovies, bacon, salmon,
herring, turkey and veal, to name a few), cut back on red meat to no more than
two to three times a week (it's also high in purines), drink at least two
quarts of liquid a day and avoid aspirin and other drugs that contain
salicylates, which can increase uric acid levels and reduce the effectiveness
of gout medications.  Remember though, you can't cure gout with your diet, for
that you need medication.
ÿ
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The material contained here is "FOR INFORMATION ONLY" and should not replace 
the counsel and advice of your personal physician.  Promptly consulting your 
doctor is the best path to a quick and successful resolution of any medical 
problem.
