Understanding Gout

Gout has long been considered a disease of kings and the consequence of gluttony. Although there is truth to these associations, gout is a complex disease resulting from many factors. Gout may be provoked by excessive consumption of foods that contain purines in susceptible individuals. Dietary sources of purines include meats, shellfish, anchovies and large quantities of lentils to name a few. Alcoholic beverages, particularly beer, and high fructose corn syrup-containing drinks also increase uric acid production in the body. 

Not all individuals are susceptible to developing gout. Purines in the body originate both from food intake and from the production of purines by the body itself. These purines can either be eliminated from the body as uric acid, the key compound causing gout attacks, or purines may be recycled in the body. Individuals who fail to eliminate enough uric acid, as a result of the balance between the amount produced and the amount the kidney can get rid of, are prone to gout. Genetics plays an important role in how the body produces and eliminates uric acid. Certain medications like aspirin and water pills can shift this balance as can certain diseases such as kidney disease, leukemia, thyroid problems and chemotherapy. 

Although dietary modification may decrease the frequency and severity of gout attacks, treatment with medication is the ultimate solution. Gout attacks are extremely painful and classically occur in the big toe. Any location in the foot or ankle is common, but attacks also occur in the elbows, knees and hands. Longstanding gout is associated with nodules or lumps of uric acid that can protrude under the skin. Some patients also develop uric acid kidney stones. 

At the onset, painful gout attacks are treated with anti-inflammatory medications such as colchicine, steroids and non-steroidal anti-inflammatory drugs. Once the attack subsides, the uric acid level in the body can be reduced with medications such as allopurinol or Uloric. As with all medications, patients must be aware of the risk of certain side effects and monitoring is required.  When the uric acid level has been reduced over a period of time, the risk of new gout attacks is decreased and, ideally, ultimately eliminated so long as the patient continues to take the medication. Generally gout can be treated very successfully, which is gratifying for both the patient and the physician.