Healthy Living

In the recent decades, the so-called “Western Diet’ and lifestyle that predisposes individuals to hyperuricemia (increased uric acid) and gout have become increasingly common and have been paralleled by a potential increase in the incidence and prevalence of gout worldwide.

Every attack of gout has a story. Every story is unique. But one common thread is that the condition can be very painful.

The most common story is after a night out at a bar having a good time. The patient is woken up by twinges of pain in the big toe and this becomes increasingly worse. The big toe becomes red, hot and painful to the point that even the sheet bothers their toe.

If this is the first time, the patient really does not know what to do and seeks medical advice either at the emergency room or calls their doctor the next day. Initially, the doctor investigates the possibility of infection in the joint.

Once the doctor rules out infection the patient is usually treated for gout with colchicines or medicines like ibuprofen or naprosyn. An acute attack usually subsides within a few days to a week. Demonstration of uric acid crystals in the joint fluid is vital for the definitive diagnosis of gout.

Risk factors for gout include:
 Blood uric acid level greater than 6.8
 Hypertension
 Medications (low dose aspirin, diuretics, certain immunosuppressive agents)
 Obesity
 Metabolic syndrome
 Intake of high purine beverages and food, including certain meats, seafood, yeast and yeast extracts, vegetables (peas, beans, lentils, asparagus, spinach, mushrooms, beer and other alcoholic drinks.

Not all patients need to take medications for the treatment of chronic gout. Dietary modifications can make a big impact and sometimes just adjusting medications can do the trick.

But sometimes longer treatment is needed, especially when a patient experiences frequent and disabling attacks; signs of gouty joint disease; Uric acid clumps in soft tissues and some bones; gout in conjunction with kidney disease and recurrent kidney stones.


Sandeep Varma, MD, is a rheumatologist and Medical Director at the Backus Arthritis Center, located at the Backus Outpatient Care Center in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Varma and all of the Healthy Living columnists at healthyliving@wwbh.org