DEAR DR. DONOHUE: The skin where my big toe joins my foot turned red and felt hot. It was painful. I decided it must be gout. To play it safe, I saw our doctor, who agreed with my diagnosis but insisted on some lab tests and withdrawing fluid from the joint. The tests came back positive for gout.
He put me on indomethacin, and the pain stopped almost overnight. I’d like to know more about gout. Will you supply some information? My wife thinks I need a special diet. Do I? — R.B.
ANSWER: Gout is an overproduction of uric acid due to the daily breakdown of cells that release DNA and RNA, the molecules of life. DNA and RNA are further degraded into uric acid. As blood levels of it rise, it diffuses into and around joints. Uric acid crystals are shaped like needles. Crystals in and near joints kick off the pain of gout. The skin over the joint turns red and becomes warm. Although the big-toe joint often is the first joint affected, the middle of the foot, the ankle and the knee also can attract uric acid crystals. If nothing is done to lower blood uric acid, a second attack occurs in about 11 months.
Treatment aims at quickly remedying the pain and more slowly reducing uric acid. Nonsteroidal anti-inflammatory drugs like your indomethacin (Indocin) are effective at abolishing pain and inflammation. If they don’t get the job done, prednisone (a cortisone drug) nips gout in the bud quickly. When colchicine was readily available in the United States, it was a reliable anti-gout medicine. For the long term, once the acute attack has cooled, then drugs that rid the body of uric acid are begun. Allopurinol (Zyloprim) and probenecid are popular choices. Newer drugs like Uloric and Krystexxa are held in reserve if the standard treatments fail.
The gout diet is simple. Cut back on your intake of red meat, seafood and fish. Poultry is fine. Reduce the consumption of high-fructose corn syrup, a sweetener found in many soft drinks. Go very easy on beer. You are better off eliminating it. Distilled liquor is less likely to induce a gout attack, but it may. Wine in moderation causes little trouble.
The booklet on gout explains this illness in greater detail. Readers can order a copy by writing: Dr. Donohue — No. 302W, Box 536475, Orlando, FL 32853- 6475. Enclose a check or money order (no cash) for $4.75 the recipient’s printed name and address. Allow four weeks for delivery.
©2013 North America Synd.