STORY BY

Meredith Raine

The first time Joseph H. Peck, Jr. had an attack of gout, he thought he had broken his big toe.

The pain was excruciating, and he needed crutches just to get to the doctor's office. X-rays revealed no fracture, so the doctor gave him medication to reduce the inexplicable inflammation in his swollen, burning toe.

It took several years and a half-dozen more attacks before he received a diagnosis – even longer before he learned that these gout attacks could be stopped with proper diet and medication.

"People who have gout think there is nothing they can do - that they just have to live with this pain, but medication can stop the attacks," Peck says. "It can be controlled to the extent that you don't even know you have gout."

The king of pain

Gout, a rheumatic disease that is caused by too much uric acid in the blood, is one of the world's earliest recorded medical conditions. It was recognized in the 5 th century B.C.E. by Hippocrates, who called it the "unwalkable disease" because needle-shaped crystals of uric acid typically settle in the big toe, making it too painful to walk. Gout also can damage other joints and even the kidneys.

Benjamin Franklin, Thomas Jefferson, Sir Isaac Newton and Charles Darwin all suffered from gout, as did King Henry VIII and other leaders.

To this day, gout is often called the "disease of kings" because of its association with rich foods and alcohol consumption. Gout affects more than one million Americans - most of whom are men older than 30.

The good news is that gout can be treated, says Dr. Frank Arnett, professor of internal medicine and the Elizabeth Bidgood Chair in Rheumatology at The University of Texas Medical School at Houston.

The bad news is that gout is often misdiagnosed, overlooked or not properly treated, so patients like Peck often endure gout pain for years before they learn how to manage the disease.

The Royal Treatment

Gout is a chronic disease and needs to be treated as such, Arnett says. It isn't enough just to treat symptoms during attacks, which cause sudden pain, joint swelling and red or purple skin around the affected joints.

"This is the problem. Patients go to bed feeling perfectly well, and in the middle of the night, they wake up to excruciating pain in their toe," Arnett says. "They can't even stand for a bed sheet to be touching their toe. They end up in the emergency room, and they are treated for the pain and inflammation. They get well.

"They can go months or years before another attack, and when that happens, they do the same thing over again - just treating the attack and not the underlying problem," Arnett says. "Meanwhile, uric acid continues to build up. Attacks become more frequent and eventually the gout begins to affect other joints and cause damage to those joints."

If detected early enough, lifestyle modifications may be the only prescription necessary. Patients may be able to eliminate their gout symptoms by losing weight, reducing alcohol and limiting certain foods that cause an increased production of uric acid. Those foods include oysters, red meat and organ foods, such as liver pâté.

"Gout is linked to being overweight and is common in those with diabetes, high cholesterol, hypertension and other high risks for heart disease," Arnett says. "Gout runs in bad company, so the best advice we can recommend is to stay slim and don't overindulge in purine-rich foods," Arnett says. "Purine turns in to uric acid, and when those levels spike, it can cause an attack of gout."

Lifestyle changes are not always enough, though. Arnett says there are plenty of trim teetotalers with gout who can only be managed with medication.

Nonsteroidal anti-inflammatory drugs, such as ibuprofen, can treat sudden and severe gout attacks. Colchicine, a specific type of anti-inflammatory may be used to prevent and treat attacks. Medication that lowers uric acid levels, such as allopurinol or probenecid, also may be prescribed.

"We can't cure gout, but we can completely eliminate the symptoms," Arnett says. "We can get rid of all that uric acid that has built up, and people can go on to lead completely normal lives."

Arnett stresses the importance of getting a comprehensive medical evaluation if you have symptoms of gout. An analysis of joint fluid is the only way to diagnose it and rule out other medical complications, such as blood and kidney disorders, that can raise uric acid levels in the blood.

"If left untreated, gout can lead to crippling arthritis that mimics rheumatoid arthritis," Arnett says. "It can do serious damage to joints and cause kidney stones and kidney damage."

Last Updated: 4-18-2005

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