In this Health Alert, Dr. Joan M. Bathon, Medical Editor of the Johns Hopkins Arthritis Bulletin, answers reader's questions about living with gout.
Q. I am a 51-year old man with a history of gout. Three weeks ago, I had a flare up of gout, with all the classic symptoms. The main joint on my big left toe had the most pain. My doctor prescribed colchicine. I have been taking .6 mg of colchicine a day as prescribed. I have also been drinking a lot of water, watching what I eat, and eliminated all beer.
Now that my symptoms have gone away and I have not had any new attacks, my foot still doesn't feel 100%. There seems to be some residual pain and my foot/toe seems very susceptible to injury. I have stubbed it a couple of times, which seems to cause a lot of lingering pain, although there has been no real gout flare up. Is this normal? Is it possible that one gout attack could cause joint damage? On the other hand, am I just not getting over the gout attack completely for some reason? Is a joint more sensitive to injury after a flare up? Thanks for your help. Princeton, NJ
A. Most gout attacks resolve within a few days. Medication can shorten the gout attack. Over time, though, if preventative medication (allopurinol) isn't used, the attacks tend to become more frequent and last longer and longer until they all run together in one continuous state of joint inflammation. At this stage, we refer to gout as "chronic" rather than "acute." In general, if an individual is having multiple attacks of gout per year, we will recommend the use of allopurinol. Currently, this is the most effective medication for lowering uric acid in the blood.
Uric acid is the chemical that causes gout. When levels of uric acid get too high, the uric acid crystallizes in the joint causing the inflammation. Allopurinol shuts down the body's ability to make uric acid, thus markedly reducing the possibility of developing any more gout attacks. Colchicine reduces inflammation but does not lower uric acid. Folks having repeated attacks of gout, or an attack that just won't quit, should consult with their primary care physicians for treatment recommendations.
Q. I was recently diagnosed with gout and my doctor told me that I have to keep it under control, not just to prevent the painful flares but more importantly because gout can increase the risk of having a heart attack. I had never heard of this before. How can a sore toe cause a heart attack? Hanover, NH
A. Many inflammatory conditions outside the heart are associated with a higher risk for developing heart attacks and strokes. Rheumatoid arthritis and lupus are the best examples of this. We think it is because these are systemic diseases in which highly inflammatory molecules are circulating around in the bloodstream, and may promote atherosclerosis as they bathe the heart day after day, year after year.
Gout may present a similar picture since uncontrolled gout consists of repeated bouts of inflammation. In addition, when one looks at folks who have heart disease, even without symptomatic gout, a high uric acid level (uric acid is the chemical that causes gout) is associated with a higher risk of heart disease. So, if you have gout, you should make sure it is kept under control, both for the sake of preserving your joints and perhaps for preserving a healthy heart, too.
