My Doctor Tells Me I Have GoutWhat Can I Do
By: Nathan Wei

Gout is a type of inflammatory arthritis triggered by crystallization of uric acid within joints. Gout is an extremely painful condition. It is often associated with other medical condition such as diabetes high blood pressure kidney abnormalities and elevated cholesterol.


The onset of gout appears to be related to both genetic as well as dietary factors. Uricase an enzyme that is required for digestion of uric acid does not function in humans because of a defective gene. The combination of this crippled gene along with dietary intake of foods high in purines leads to elevated levels of blood uric acid.


Certain foods such as red meat shellfish peas beans lentils and spinach are high in purine content. Interestingly it is the animal derived purines (meat and shellfish) which tend to increase the risk for gout while the plantderived purines do not appear to.


Alcohol in the form of beer and red wine is a definite trigger for gout. It increases the production of uric acid and blocks the excretion of uric acid by the body.


Acute gout tends to affect joints such as the great toe foot ankle and knee. Occasionally the wrist and elbow may also be affected. A typical attack of gout begins in the early morning with swelling redness heat and pain. The pain is so intense that even the weight of a bed sheet cannot be tolerated on the affected joint. Acute attacks are treated with nonsteroidal antiinflammatory drugs colchicines and occasionally steroids. Weight and diet control measures along with abstinence

from alcohol are secondary measures.


Chronic gout which is gout that has gone on for several years may affect virtually any joint. Chronic gout causes a particularly severe deforming type of arthritis. Patients have large deposits of uric acid called tophi in the joints and under the skin. Patients with chronic gout require uric acid lowering therapy. Drugs like probenecid are usually effective in patients with normal kidney function so long as they are not already excreting large amounts of uric acid in the urine. If they are then probenecid should not be used.


Allopurinol is the drug that the majority of people who require uricacid lowering therapy go on. Unfortunately while it is effective it is also extremely toxic and must be used cautiously by experienced physicians.


A new drug febuxostat is currently awaiting approval by the FDA and will offer an alternative to allopurinol.


Lifestyle modifications should include weight control limits on red meat and shell fish consumption and daily exercise.


Patients should also have comorbid conditions such as hypertension elevated cholesterol and diabetes addressed.

Dr. Wei (pronounced way) is a boardcertified rheumatologist and Clinical Director of the nationally respected Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and has served as a consultant to the Arthritis Branch of the National Institutes of Health. He is a Fellow of the American College of Rheumatology and the American College of Physicians. For more information on arthritis and related conditions go to: http://www.arthritistreatmentandrelief.com


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