PRESCRIPTIONS
Cut back on alcohol, drop weight to gang up on gout
By Landis Lum
Q. What is gout, and what causes it?
A. You may be awakened by a severe pain in the big toe; more rarely in the heel, ankle, instep, knee, wrist, finger, or elbow. It may be so bad you can't bear the weight of your pajamas or the jar of someone walking in the room.
Gout is an arthritis six times more common in men than women. Untreated, it can last hours to days. The peak age of onset is 45.
What causes it? The body makes uric acid from foods with a high purine content, such as organ meats like liver, sardines and shellfish. Excess uric acid accumulates in the body (usually from an inherited inability of the kidneys to get rid of it) and forms crystals in the joint fluid. White blood cells try to attack and get rid of these crystals, but in their unsuccessful attempt to destroy them, they release natural chemicals of inflammation into the joint space, causing pain, swelling and redness.
Crystals may cause lumps under the skin called tophi. These may occur anywhere, like the hands, wrists, elbows, or knees.
Certain racial groups such as Filipinos have a really high risk of gout. Their kidneys have a limited ability to get rid of uric acid, thereby increasing uric acid blood levels. What's more, Filipinos have a high frequency of high blood pressure, and diuretics (water pills) commonly used to treat this also increase uric acid.
Gout pain can be treated with anti-inflammatories like Motrin. Indomethacin is often given, but is likely no better than other agents — and causes more stomach problems, headaches and mental dysfunction.
You can reduce gout attacks by reducing alcohol intake or losing weight. Low-purine diets are hard to stick to and don't work THAT well.
If you have more than two attacks a year or have tophi, drugs like Allopurinol or Probenecid to lower uric acid to less than six should be started, but wait 3-4 weeks till the pain is gone (or bad pain might return).
High uric acid should not be treated if you never had gout, because there ’s less than a 1-in-5 chance you'll ever get gout.
With allopurinol, if you get a rash with fever or fatigue, stop it immediately and see a doctor because this may be a hypersensitivity reaction which is sometimes fatal.
You should also take another pill called colchicine the first few months to prevent gout while your uric acid is lowered to six. Colchicine and allopurinol doses should be reduced with kidney dysfunction.
Gout in the elderly may be unusual in that there may not be the severe pain and swelling seen in younger folks, and can involve multiple joints and be chronic.
Dr. Landis Lum is a family-practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i's John A. Burns School of Medicine. Send your questions to Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Hono-lulu, HI 96802; fax 535-8170; or write islandlife@honoluluadvertiser.com. This column is not intended to provide medical advice.
