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Gout
GOUT: THE KING OF DISEASES AND THE DISEASE OF KINGS
Mr. Wiliams, a 50-year-old successful businessman had a long history of hypertension. After his promotion, he went on a seven-day cruise to celebrate. The first three days were filled with eating seafood and steak, drinking lots of beer, dancing and let’s not forget the midnight buffet. On the fourth day, he awoke with severe pain and swelling in his right toe and right ankle. He was not even able to put on his socks. So, for the next few days, his reward for all his celebrating was a cane to help him walk. Mr. Johnson was experiencing a gout attack.
Gout is caused by the deposit of uric acid crystals in the joints, resulting in severe swelling and pain. This disease mostly affects men between the ages of 30 and 45 and women between 55 and 70. And its occurrence is more prominent in blacks then in whites because of the higher rate of hypertension. Also, gout is commonly seen in people who are obese and suffer from diabetes or hyperlipidemia.
Uric acid, a substance from the breakdown of purine from food or our own body, usually dissolves in our blood, passing through the kidneys and then excreted though urine. However, if the body produces more uric acid than the kidneys can excrete, the uric acid can accumulate in the joints and kidneys. When uric acid builds up in our joints, creating urate crystals, it can trigger intense swelling and pain. This process can occur in almost any joint such as ankles, heels, knees, wrists, fingers or elbows, however the big toe is usually the first one to be affected.
A gout attack is usually very sudden and is triggered by fluctuations in serum uric acid, produced by excessive intake of certain foods and alcohol, trauma or diuretic therapy. A person can go to bed feeling fine and wake up with an excruciating painful, hot and swollen big toe, ankle or foot. Between attacks, the patient can feel perfectly fine and not experience joint pain or swelling. Some patients never have a recurrence, however, attacks can recur in several months to several years. Thankfully, only a small percent of patients who suffer an acute attack will continue to chronic problems without remission.
Your physician will prescribe non-steroidal anti-inflammatory drugs (NSAIDs) which are very effective for acute gout attacks. The strategy is to take double the usual daily dose with food for the first two days, followed by the regular recommended dose for about one week and then taper the dosage to none. Another drug used in treating gout is Colchocine. However, its use is limited because of GI side effects. If you are taking Allopurinol or a diuretic, these should not be changed as they could also affect your serum uric acid level.
By Dr. Yong H. Tsai
Published in The Daytona Beach News-Journal
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