Dear Dr. Donohue: I am a man of 64 years. Please discuss gout. - J.R.
Dear J.R.: In the bad old days, people believed gout to be the illness only of aristocrats who ate rich foods and drank fine wine. Now it's an illness for everyone, but mostly it's a man's illness.
Gout occurs when the blood uric acid level rises. Uric acid is a byproduct of daily cell recycling. People with gout either have kidneys that don't get rid of uric acid or bodies that produce too much of it. Uric acid in the blood penetrates joints and inflames them. The joint at the base of the big toe is gout's favorite target, but it also strikes ankles, knees, hands and elbows.
The affected joint turns red, becomes hot and cannot stand the slightest pressure. Pain can be intolerable. The diagnosis is established by finding uric acid crystals in the fluid drained from an involved joint and seeing uric acid crystals in it through microscopic examination.
In the old days, diet was its only treatment. In the good new days, medicines control it. Nonsteroidal anti-inflammatory medicines like Indocin (indomethacin) bring fairly rapid relief from a gout attack. Colchicine, an older drug, is still used, but less often than it was.
To prevent gout attacks from recurring, Zyloprim (allopurinol) stops uric acid production. Or Benemid (probenecid) prods the kidneys to remove more of it. A new drug, Uloric, also puts a halt to uric acid production. Weight loss is another way to prevent further attacks. Low-fat dairy products also lessen their occurrence. Diet isn't the concern it used to be when there were no gout medicines.
Write to Paul Donohue, M.D., P.O. Box 536475, Orlando, FL 32853-6475.