Excruciating pain in a joint, usually the big toe, is often the first indicator for gout. According to about.com, this buildup of uric acid crystals occurs most often in men in their 40s and is much more common in developed nations with high-protein diets. In those 55 and older gout occurs more equally among men and women. After the age of 80, it occurs more in women and overall, it is extremely rare in children. There also seems to be a correlation with high blood pressure and the use of diuretics as well as a strong link to family history.
Dr. Joanne Perez, internal medicine/geriatric medicine with Providence St. Mary Medical Center said, "Gout is a disease that is characterized by an inflammatory response" to crystals of uric acid. According to Dr. Perez it manifests as redness, excessive pain, warmth and swelling in a joint, most commonly the base of the big toe.
"Most patients have long standing hyperuricemia, some just have more uric acid than others," she said. Many factors contribute to whether or not you'll ever have the disease. According to Dr. Perez, these factors include genetics, medications, alcohol and diet.
Possible triggers of an attack could include large amounts of animal protein, especially organ meats such as kidney and liver. "Also a drinking spree can trigger it, alcohol can contribute to it happening," she said. "Maybe the next morning or the next week you'll have an acute gouty flare."
According to Dr. Perez gout affects men more than women. "It peaks between 40 and 60 for men and 60 to 80 for women. The reason for this disparity is that higher levels of estrogen protects younger women from hyperuricemia. Estrogen flushes it out. After menopause, the estrogen decreases so the protective effect goes away."
Sometimes drinking more water helps, staying hydrated can help keep uric acid less concentrated. But everyone's health situation is different, there's no overall prevention method or solution that fits everyone. "For some people, it may take a couple of decades to have a flare up," she said. "The early phases are most often in the lower extremities, the big toe most often. Fifty percent of them occur in the big toe."
According to Dr. Perez, some people are actually fortunate enough to have one flare up and then never again. But some have recurring attacks. But doctors can recommend a variety of medicines to keep it at bay. Among the most common treatments are non steroidal anti-inflamatory drugs, known as NSAIDS.
However, some dietary changes to prevent the attacks in the first place might be in order.
"A patient with gout has to be careful to avoid foods high in purines, such as animal protein, especially organ meats," she said. There's also a high concentration of purines in asparagus, mushrooms, shellfish such as lobster, herring, mackerel, anchovies. She suggested avoiding alcohol. These factors have contributed to gout being associated with affluence, bringing more protein foods and alcohol into the diet.
According to Dr. Perez, keep hydrated; if overweight, lose weight, since obesity is a risk factor. Eat a balanced diet with fewer of the possible trigger foods, possibly avoiding meat and alcohol.
Dr. Perez suggested to think long term, while it's possible you'll have an attack only once but "the majority will have subsequent attacks.
Doctors will determine treatment based on other medical conditions. It's not just for an acute attack. It's long term, to help prevent another attack."
Karlene Ponti can be reached by calling 509-526-8324 or by e-mail at firstname.lastname@example.org.