— Noel, Louisiana Unfortunately, gout can spread throughout the body, and it can be most painful and unpleasant. Gout is known as the “the disease of kings" or “a rich man’s disease” because it is thought to be linked to a diet that contains a lot of meat, seafood, and alcohol, which all increase uric-acid levels in the body. With gout, uric-acid crystals are deposited in the bloodstream, joints, tendons, and surrounding tissues, causing pain and stiffness. The usual treatment is to start on a drug, such as Zyloprim (allopurinol), that inhibits the conversion of purine in foods into uric acid; instead the purine is eliminated through urine and feces. If a gout patient does not get relief with this class of drug, the next class to consider is the uricosurics — Benuryl (probenecid) is one example — which work to increase the excretion of uric acid from the body. However, because of the known side effects of Benuryl, this drug is often reserved as a second line of defense against gout. Still, a patient whose symptoms are not relieved by Zyloprim should be switched to Benuryl promptly. NSAIDS (non-steroidal anti-inflammatory drugs) such as Indocin (indomethacin) can be helpful against the pain brought on by gout in some cases, although they do not appear to be working well in your husband’s situation. Sometimes surgery may be necessary to remove large uric-acid crystal deposits (called tophi) and to correct joint deformity. Q2. My husband was just diagnosed with gout after experiencing severe inflammation and pain in his foot. He could not walk for days. His doctor prescribed a few medications, one he is to take daily. Is gout the same as rheumatoid arthritis? Should he see a rheumatologist? Are olives harmful to eat because of gout? Although both can cause pain and swelling of joints, gout and rheumatoid arthritis are two different diseases. Rheumatoid arthritis is caused by an immune system that isn’t regulating itself well. Gout, on the other hand, is caused by high levels of uric acid in the blood. This acid is formed when your body breaks down purine, a substance that is found in DNA. When uric acid accumulates in the joint and forms crystals, it results in pain and inflammation. Uric acid can also form kidney stones. Foods such as meat (especially organ meats like liver), seafood (anchovies) and beer are high in purine. Eating these foods can increase the risk of having a gout attack. Foods such as olives, cereals, eggs, cheese and nuts contain low amounts of purine and so are not harmful to eat. Eating low-fat dairy products can help decrease the risk of having an attack of gout. Gout can be controlled with medications such as allopurinol (Aloprim, Zyloprim). Some cases of gout can be easily managed by your primary care physician. Other cases of gout are more difficult to control and require treatment by a rheumatologist. Q3. What dietary restrictions should I follow to prevent another attack of gout? Gout is the result of an excess of monosodium urate crystals in the body. When the crystals accumulate in the spaces between joints, they can cause excruciating pain, most commonly felt in the big toe. Indulging in meat, seafood, and alcohol can play a role. Studies have shown that individuals who are prone to developing gout should reduce their intake of meats and seafood because these foods promote uric acid formation. Low-fat diet products, on the other hand, appear to decrease the risk of gout. Protein consumption has no effect, while alcohol raises uric acid levels, which may provoke an episode of gout. It is recommended that people at risk for gout drink 10 to 12 eight-ounce glasses of nonalcoholic liquids every day to reduce the risk of developing kidney stones. Drinking plenty of fluid helps to flush the body of uric acid crystals, which characteristically accumulate in people with this disease. It is also suggested that gout sufferers maintain a stable weight, work to avoid obesity, and avoid using diuretics or water pills. Learn more in the Everyday Health Rheumatic Diseases Center.
