Wednesday, April 13, 2011


Even though gout has gotten a lot of publicity in the recent years, it actually has been around a couple of thousand years. There are reports that mummies in Egypt had evidence of gout when dug up in the pyramids. In the past, it was called rich man’s disease, as it has been related to foods the supposed wealthy eat, such as steaks.

What is gout? Gout is a painful and often debilitating condition that develops in people that have a high blood substance called urate which is the breakdown product of protein. Not everyone with high levels of urate (also called uric acid) develops gout and up to two-thirds of those with high levels never get gout. We do not know why some do and some don’t.

Joints are the main areas of involvement of gout, classically the big toe. Other parts of the body can be affected as well such as the kidney or urinary tract causing kidney stones (uric acid stones cause 15% of stones).

A gout attack can cause a sudden intense pain in the joint. This is usually associated with redness, swelling, and tenderness of the joint. An attack usually is in one joint, but some people develop a few inflamed joints at the same time. The pain peaks within several hours but can resolve spontaneously after a few days. I believe an attack should be treated, as gout may destroy a joint. Anti- inflammatory medications are the mainstay of treatment.

What are characteristics that increase risk? Those would be obesity, high blood pressure, a recent trauma, fasting, consuming excessive amounts of alcohol especially beer or spirits but not wine, eating meat or seafood, and taking certain medications such as diuretics.

There are three phases of gout: Acute -with the above noted symptoms of redness, swelling, pain; Inter-critical period- a second attack of gout that typically occurs within two years; and chronic phase. People who have recurrent attacks may develop tophaceous gout which are large number of urate crystals that collect in joints, bones, and cartilage. These tophi can cause the joint to become damaged and even deformed.

Do you need to treat? Yes! First, for the pain which can be severe; second,to help prevent chronic gout which may threaten the joint; third, to help prevent uric acid stones; and fourthly,to decrease the overall load of uric acid in the body which may be a cardiovascular risk factor.

After the acute treatment, prophylactic therapy is usually done to prevent or reduce recurrences. The most common therapy is allopurinol which is a medication that decreases the formation of uric acid in the body. It may take weeks or months to lower the total amount of uric acid in the body. During this time, it is important to drink plenty of water and adjust the diet to more fruits and vegetables, less red meat, less seafood, less beer and hard liquor, less high fructose containing foods with corn syrup( some diet sodas). You are encouraged to eat and drink low fat dairy products, eat foods made with complex carbohydrates( whole grains, brown rice, oats, beans), a moderate amount of wine( 1-2 five ounce servings per day), coffee( this may actually decrease the risk of a gout attack), and vitamin C( 500 mg. per day) which increases the release of uric acid in the urine. Please note that a change in diet alone without the use of some preventive medication is not likely to work very well as diet alone lowers blood urate levels only by 15-20%.

Finally, do not be surprised if your doctor wants to aspirate the fluid in your involved joint. This is the best way to be sure of the diagnosis of gout. The fluid once tapped would then be sent for analysis of crystals.


Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
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