By Dr. Allen Douma
Tribune Media Services
Q: I don't know if I have gout or not. My podiatrist took an X-ray of my instep and showed me where I had gout. Later I went to a rheumatologist, who told me that I had to have fluid drained from the joint and examined for gout crystals, but the joint was too small. Which doctor is right? For the gout, I don't eat beans. I also have high cholesterol, so I don't want to eat meat. I'm concerned about not getting enough protein.
A: Gout is characterized by sudden, recurring attacks of painful arthritis in the joints.
The most susceptible joint is that of the big toe, but joints of the feet, ankles and knees are commonly affected as well. About 90 percent of the people with gout are men, usually over 30.
ADVERTISEMENT
The pain of an acute gout episode is typically severe, affecting one or more joints, and most often occurring at night. In the beginning, the attacks come and go with no symptoms between episodes, but later, especially without treatment, the attacks are more frequent, longer lasting and more severe.
You didn't mention symptoms. Do these symptoms sound like what you're experiencing?
The pain and swelling of gout is associated with deposits of uric acid crystals in the joints. The deposits result from high amounts of uric acid in the blood. It's caused by increased production or decreased excretion of another chemical called purine. This results from poor diet, surgery, infection, drugs and other chemicals.
Both your doctors are correct regarding diagnosis. Although X-rays don't show much change early in the disease, later they can show development of erosions of the bone.
Also, finding sodium urate crystals in the fluid surrounding a joint suspected of being gouty does confirm the diagnosis. A series of blood tests for uric acid in the serum during the course of an attack may help with diagnosis. Did the rheumatologist do these tests?
Treatment is a two-pronged approach. The first step is to treat the symptoms of the actual gout attack. Nonsteroidal anti-inflammatory drugs that do not contain salicylates are most often recommended to relieve the pain.
Colchicine is a unique anti-inflammatory drug largely effective only against gout. Celestone (betamethasone) is another anti-inflammatory drug considered effective in treating acute gouty arthritis.
The next step is to deal with the gout during symptom-free periods, that is, to minimize the hyperuricemia and thereby reduce the frequency and severity of recurring episodes. Here is where diet and lifestyle are most important.
ADVERTISEMENT
Foods that contain high amounts of purines, including all meats (but especially organ meats), beer and other alcoholic beverages, members of the bean family, spinach, asparagus, cauliflower, and mushrooms should be avoided. Low-purine foods include cereals, pasta, milk, eggs, butter, fruits and tomatoes.
High fluid intake, especially when sweating and, more importantly, high urinary output (two quarts or more a day), can help flush out the excess uric acid. Diuretics, because they tend to dehydrate the body, should be avoided.
Uricosuric drugs increase the rate of excretion of uric acid. Probenecid and sulfinpyrazone are two common uricosuric drugs. Allopurinol decreases the formation of uric acid in the first place.
