Gout is a type of inflammatory arthritis triggered by crystallization of uric acid within joints. Gout is an extremely painful condition. It is often associated with other medical condition such as diabetes, high blood pressure, kidney abnormalities, and elevated cholesterol.

The onset of gout appears to be related to both genetic as well as dietary factors. Uricase, an enzyme that is required for digestion of uric acid, does not function in humans because of a defective gene. The combination of this crippled gene along with dietary intake of foods high in purines leads to elevated levels of blood uric acid.

Certain foods such as red meat, shellfish, peas, beans, lentils, and spinach are high in purine content. Interestingly, it is the animal derived purines (meat and shellfish) which tend to increase the risk for gout while the plant-derived purines do not appear to.

Alcohol, in the form of beer and red wine, is a definite trigger for gout. It increases the production of uric acid and blocks the excretion of uric acid by the body.

Acute gout tends to affect joints such as the great toe, foot, ankle, and knee. Occasionally the wrist and elbow may also be affected. A typical attack of gout begins in the early morning with swelling, redness, heat, and pain. The pain is so intense that even the weight of a bed sheet cannot be tolerated on the affected joint. Acute attacks are treated with non-steroidal anti-inflammatory drugs, colchicines, and occasionally steroids. Weight and diet control measures along with abstinence from alcohol are secondary measures.

Chronic gout, which is gout that has gone on for several years, may affect virtually any joint. Chronic gout causes a particularly severe deforming type of arthritis. Patients have large deposits of uric acid, called tophi, in the joints and under the skin. Patients with chronic gout require uric acid lowering therapy. Drugs like probenecid are usually effective in patients with normal kidney function so long as they are not already excreting large amounts of uric acid in the urine. If they are, then probenecid should not be used.

Allopurinol is the drug that the majority of people who require uric-acid lowering therapy go on. Unfortunately, while it is effective, it is also extremely toxic and must be used cautiously by experienced physicians.

A new drug, febuxostat, is currently awaiting approval by the FDA and will offer an alternative to allopurinol.

Lifestyle modifications should include weight control, limits on red meat and shell fish consumption, and daily exercise.

Patients should also have co-morbid conditions such as hypertension, elevated cholesterol, and diabetes addressed.

Dr. Wei (pronounced