Most of us have some experience, either through a friend, family member, or personal familiarity, with the disorder known as gout. The stereotypical vision of a gout sufferer, for many of us, is a curmudgeon, sitting with his bandaged foot on a stool by the fireplace, with a swollen red toe sticking out of the gauze. This may be the traditional perception of gout, but a more realistic image would include healthy, active individuals in all stages of life. What is gout, and what is the latest and greatest treatment option?

Gout is a type of arthritis, characterized by an attack of sudden burning pain, stiffness, and swelling in a joint, usually the big toe, as in the case of our stereotypical curmudgeon. Over time, if left untreated, gout can harm joints, tendons, and other tissues.

Gout is caused by too much uric acid in the bloodstream, but that’s not really what causes a gout disorder, since many people with extremely high levels of uric acid seldom suffer from gout. It is when the uric acid forms hard crystals in your joints that the symptoms of gout are produced. Crystal formation in joints occurs more frequently when you are overweight, when you occasionally drink too much alcohol, or when you choose to eat foods high in purines, such as meat and fish. With that information as background, it is easy to see why gout was considered a disease of royalty in medieval times – peasants weren’t exactly overweight, and they were seldom washing down plates of mutton with a few bottles of wine.

Both in medieval times and today, the most common symptom of gout is swelling, tenderness, redness, and sharp pain, usually in our stereotypical big toe, but it can occur in any joint. The attack may last a few days, or can linger for several weeks before the pain goes away, and once the attack has subsided, another attack may not occur for several months, or even years. To determine if you are, in fact, suffering from gout, a fluid sample is removed from the joint, and is analyzed for uric acid crystals. In addition, a blood test may be done to measure the amount of uric acid in your bloodstream, but the joint fluid sample is the best way to arrive at a positive diagnosis for gout.

Once the pain in your joint is identified as gout, there are several treatment methods that may be implemented, usually in two separate stages. First, the acute attack is treated with medication until the symptoms have gone away. Following this, as the second stage of treatment, medication to reduce uric acid levels may be prescribed, after the inflammation has subsided for two to four weeks. (Taking medication to lower uric acid levels during an acute gout attack may actually make the condition worse, which is why it is recommended to wait a few weeks following an acute attack before starting these prescriptions.) Zyloprim (allopurinol) and Benemid (probenecid), are examples of drugs that lower uric acid levels, and as such, may cause movement of uric acid stored elsewhere in the body, exacerbating the acute attack. If you are already taking either of these medications, you should continue their use, even during an acute gout attack, but if you have not started the medications, if is not recommended to begin them during the acute attack, since, again, it could make the acute gout attack worse.

During an acute attack of gout, there are several treatment options, which include Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), colchicine, or corticosteroids, such as prednisone, should the NSAIDs and colchicine fail to yield results. Once the acute symptoms are under control for a few weeks, long-term treatment may be implemented to further lower uric acid levels, which may reduce the frequency and severity of future gout attacks.

Anturane (sulfinpyrazone) and Benemid (probenecid) are examples of uricosuric agents that increase the elimination of uric acid by the kidneys. Zyloprim (allopurinol) is another uric acid lowering medication that is given on a regular, long-term basis, to decrease the chances of an acute gout attack. Colchicine may be given regularly to prevent acute gout attacks during the first few months that uric acid lowering medications are prescribed, as well.

Never take aspirin during an acute gout attack, since it actually slows the elimination of uric acid, and may further raise uric acid levels.

Gout attacks may increase during chemotherapy treatment, since dying cancer cells release (You guessed it.) uric acid into the bloodstream, and one of the newest medications for gout addresses that very issue. You’ll be able to read all about it in next week’s edition of “The Pill Box.”