If you've ever had gout, you know the true meaning of pain.
Gout is a nasty type of arthritis that usually affects a single joint in the foot -- most often the big toe. The first attack usually occurs overnight, without warning. You awaken to excruciating pain; the affected joint is red, hot, swollen and tender beyond belief.Although gout can strike without warning, the attack has probably been mounting for awhile. Gout occurs when levels of a chemical called uric acid get too high in the bloodstream.
Everyone produces uric acid as part of normal body functions, and you get some from the foods that you eat. If you're healthy, your kidneys dump excess uric acid into the urine, so that it doesn't accumulate in the blood.
But others aren't so fortunate. People with gout tend to make too much uric acid or have trouble excreting it, and the excess uric acid in the blood ends up being deposited at various sites throughout the body. In the skin, it forms ugly lumps called tophi; in the kidneys, it can form kidney stones.
Uric acid also likes to hang out in joints -- especially in the foot -- where it forms long needle-like crystals. These prickly crystals trigger a violent inflammatory reaction and excruciating pain.
Ninety percent of the people who suffer from gout are men, usually 30 to 60 years old. Most women will never know the agony of gout, but if they do, they probably won't have to contend with it until after menopause. Gout is rare in pre-menopausal women, and it's almost unheard of in kids younger than 18.
Years ago, gout was thought to be a fitting punishment for rich and royal people who lived a leisurely life of excess. We now know that gout crosses all socioeconomic lines -- it can affect anyone. Excessive consumption of alcohol and rich food can trigger an attack, but most people with gout probably inherited the tendency from their parents.
The initial attack usually resolves in a few days to a few weeks, and if you're lucky, you'll never have it again. More often, the second bout with gout strikes in a few months or years, and it's almost always worse. It usually involves other joints, lasts longer and produces more severe pain.
Ten percent to 15 percent of people with gout will go on to develop chronic gouty arthritis, a condition in which the gout is there to stay. As more joints are involved and the disease becomes more severe, the affected joints become grossly deformed, and occasionally even disabled.
If you've had gout, you can take a few steps to prevent flare-ups. Gout-producing uric acid is more likely to crystallize in your joints if you're dehydrated, so drink plenty of water every day to flush out the excess uric acid in your urine.
Avoid foods that are high in fat and rich in purines. Purines are chemicals that are converted to uric acid in the blood, and they're abundant in foods like sardines and anchovies, meat products, seafood and yeast products. You should also steer clear of high purine foods from the plant kingdom, including beans and peas, lentils, oatmeal, spinach, asparagus, cauliflower and mushrooms.
Alcohol should be avoided at all costs. Not only is it a source of uric acid-producing purines, it also hinders the kidneys' ability to excrete the chemicals. If you already have too much uric acid in your blood, just one or two nights of modest imbibing can be enough to send your levels soaring, reactivating your gout.
Overweight men are at greatest risk of having high uric levels, but rapid weight loss isn't the answer -- it's just one more way to precipitate an attack of gout.
Many gout-stricken men have high blood pressure, so keeping your blood pressure under control can help prevent future attacks. Unfortunately, some drugs -- especially diuretics -- prescribed to lower blood pressure can actually increase levels of uric acid.
If you should be so unlucky as to be struck with gout, your doctor will probably prescribe a nonsteroidal anti-inflammatory drug, like Indocin, Naprosyn or Ibuprofen for the first days of the attack. A drug called colchicine is also effective when taken early enough, but it's poorly tolerated. About 80 percent of the people taking it complain of gastrointestinal misery, like nausea, vomiting, cramping and diarrhea.
Bed rest is key -- you should stay off your feet with the affected joint elevated and periodically iced for at least 24 hours. Overdoing it too soon will only prolong your agony and precipitate a recurrence.
If you have attacks that are frequent or unusually severe, your doctor may prescribe medicines that can lower uric acid levels and reverse the deposit of crystals in your joints. These can help prevent future gout attacks, but they must be taken regularly.
If you think you're having a bout with gout, see your doctor. Without treatment, acute attacks can last for weeks, but proper treatment can stop gout before it stops you.
Rallie McAllister, M.D., M.P.H., is a family physician in Kingsport, Tenn.