Gout: The pain that can be prevented

Everyone in the CNMI has—or at least knows someone who has—suffered from the pain of gout. Gout can attack any joint, but the most typical joint is at the base of the big toe. Woodcut paintings from the 1700’s display exactly what the pain is like. They show a man, with his foot propped up on a stool and a look of agony on his face. The cause of his pain is very clear; batwing demons have their fangs sunk deep into his foot.

Before I personally had a gout attack, I thought this was just an amusing old picture. Then I experienced it for myself. The books said it was quite painful, that often the sufferer did not want the weight of the bed sheets on their foot. This account, I found out, wasn’t quite accurate. I did not want anyone looking at it, did not want a breeze blowing over it, it HURT!

The cause of this pain is the chemical “uric acid.” Uric acid is a kind of ash that is left over when the body burns certain parts of food to make energy. In some people, the body makes too much of this chemical, and it can then form tiny, sharp crystals. In the joint, these crystals tear up white blood cells and release other chemicals that are very irritating to the joint. Sometimes there is so much uric acid that the crystals start to form lumps called tophi, or tophaceous gout, usually visible under the skin. This can be more serious, since these deposits can build up in the kidneys and lead to kidney failure.

While dietary changes emphasizing carbohydrate restriction and weight reduction and avoiding alcohol are all thought to be of benefit, gout is mostly treated in two ways. For the immediate relief of pain, anti-inflammatory drugs like colchicine, ibuprofen, or even prednisone are used. If a person is having rare attacks, like one to three a year, this may be enough. But if the attacks are more frequent, or the uric acid levels in the blood are so high that tophi are forming, then the level of uric acid in the body has to be lowered. The commonest drug for this is allopurinol, which is inexpensive. The dose has to be started slowly and then built up. Yes, it means having to take a pill every day forever, but it also means no more gout attacks, and a lower risk of kidney disease.

So, if you are among those of us who suffer from gout, talk to your primary care provider to decide what treatment is best for you. And tell those demons that chew on your foot to be gone!

Dr. David Grauman is a physician at the Commonwealth Healthcare Corp.