11/05/07

By Kermit B. Fernander, Guardian Lifestyles Reporter

kermit@nasguard.com

Picture this: You're awakened in the middle of the night with a severe pain in your big toe, which is hot, swollen and so tender that even the weight of a blanket or sheet on it is unbearable. Chances are, you are having an acute attack of gout.

And gout is a form of arthritis, and technically speaking, arthritis implies inflammation of any joint, as a result, another name for gout is "gouty arthritis", which involves sudden, severe attacks of pain, redness and tenderness in joints. Apart from your big toe, you can also get gout attacks in your foot, ankle, elbow or knee.

These attacks can occur repeatedly unless gout is

treated, and attacks can last a few days or many weeks before the pain goes away. And a further attack may not occur for months or even years.

Gout is caused by having too much uric acid (a waste product derived from normal body processes, and is also found in certain foods and alcohol in the blood)

Uric acid is a waste product derived from normal body processes, and is also found in certain foods and alcohol. Foods rich in uric acid include organ meats like liver, kidney and brains — anchovies, herrings, asparagus and mushrooms. Some medicines like water pills (or diuretics) used to treat high blood pressure can also precipitate gout.

Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes your body either produces too much uric acid or excretes too little of this acid. The acid accumulates, forming sharp, needle-like crystals in a joint or surrounding tissue that causes pain, inflammation and swelling.

Approximately one out of five people with gout has a family history of the condition which occurs more often in men than women, primarily because women have lower levels of uric acid. After menopause, though, women's uric acid levels approach those of men. Men typically get gout between 40 and 50 years of age.

The pain of gout is so severe, you will probably be forced to see your doctor who will likely take a sample of fluid from the affected joint to look for uric crystals. Your doctor may also order a blood test to measure the amount of uric acid in your blood.

For relief of pain and inflammation, common drugs of choice include non-steroidal, anti-inflammatory drugs (NSAIDs), such as ibuprofen (also known as Advil or Motrin) and naproxen (also known as Aleve). Bear in mind that these medicines can cause side effects, including stomach pain, bleeding and ulcers.

In addition, there is a ceiling or limit as to how much pain they can control. This means that, beyond a certain dosage, they will not provide additional benefits so it is pointless — as well as dangerous — to increase the dosage to obtain greater pain control. Incidentally, aspirin is not recommended because aspirin increases the level of uric acid.

For severe cases, your doctor may prescribe a corticosteroid such as prednisone. Once the acute attack is under control, your doctor may recommend preventive treatment to slow the rate at which your body produces uric acid or to increase the rate at which it is excreted.

Some people with gout develop a chronic form of arthritis often with discolored chalky deposits under the skin called tophi. A small number of people with gout also develop kidney stones.

It is important to understand that it may not necessarily be the level of uric acid that triggers an acute attack of gout. Frequently, acute attacks are precipitated by a rapid change of uric acid, either up or down. Additionally, the tendency towards developing gout seems to be significantly influenced by factors like heredity that are beyond the control of any individual.

Self-care

n Avoid excessive amounts of meats like liver, brains, kidney, anchovies, herring and mackerel — they increase levels of uric acid in the body.

n Avoid excess alcohol consumption. For men this implies no more than two drinks per day; for women no more than one drink per day. During a gout attack, avoid drinking alcohol altogether. Alcohol can inhibit the excretion of uric acid.

n Increase your intake of water and non-alcoholic drinks because fluids will help to dilute uric acid in your body.

n Avoid weight gain. Gradual weight loss will lessen the load on affected weight-bearing joints. Losing weight may also decrease uric acid levels. Avoid fasting or rapid weight loss because doing so may temporarily raise uric acid levels. Gaining 30 pounds or more than your ideal weight during adulthood also increases your risk.

n Avoid certain medications. These include the use of certain water pills or diuretics used to treat high blood pressure. Low-dose aspirin therapy also increases uric acid levels. So also can anti-rejection drugs prescribed for people after undergoing transplant surgery.