By Gilda Morales, ANP, DC
GOUT
Gout is an extremely painful arthritic condition that is caused by excess uric acid accumulations in the joints, most commonly, the great toes. Uric acid is caused by the breakdown of certain foods such as red meat, seafood, cheese and consuming too much alcohol, especially beer. Certain medication such as diuretics and niacin may also contribute to a gout attack.
Gout is more than three times more prevalent in men over 40, and there are certain risk factors that make it more likely to develop gout including high blood pressure, diabetes, high cholesterol, obesity, congestive heart failure, kidney disease and high fructose intake.
The classic presentation of gout is intense pain in the great toe, but sometimes in the ankle or knee joints and less commonly in the elbow. The joint may appear swollen, warm and red and can be so tender, that even a bed sheet may cause intense pain, and occasionally, there may be fever.
Treatment that can be done at home includes ice to the affected joint and over the counter NSAIDs such as Naproxen (Aleve) 750 mg initially, then 250 mg every eight hours for 5 to 8 days. Prescription medication includes Indomethacin, at 50 to 150 mg per day for 2 to 7 days, and corticosteroids, such as a Medrol dose pack can also be used with NSAIDS. If recurrent gout attacks are common, usual treatment is to prescribe a medication that will lower the levels of uric acid in the body, such as Allopurinol at 100mg per day to a maximum of 300 mg per day.
After the acute attack has resolved, there are several measures that can be taken to prevent future bouts. Organ meats, such as liver or kidney should be avoided as well as sodas and other beverages and other foods that are sweetened with high-fructose syrup. High consumption of alcohol, which is defined at more than 2 servings of alcohol per day in men and more than 1 serving per day in women, should be avoided.
