Diet is the first line of defense against gout

On Call

June 04, 1996|By Dr. Simeon Margolis | Dr. Simeon Margolis,SPECIAL TO THE SUN

Several weeks ago, after an attack of severe pain in my right big toe, my doctor told me that I have gout. I am otherwise completely healthy and would like to know what can be done to prevent another attack.

Gout is a generalized disorder that is due to elevated levels of uric acid in the blood. The most prominent manifestations of gout are painful episodes of acute arthritis, often first involving the great toe, due to the deposition of uric acid crystals in the joints. These crystals trigger the entry of white blood cells into the joint, where they engulf the crystals and release substances that cause the arthritis attack.

Further attacks can be prevented either by reducing blood levels of uric acid or by interrupting the action of the white blood cells.

Blood uric acid levels can be lowered by decreasing the body's production of uric acid or by increasing its excretion in the urine. The most effective lifestyle measures to slow uric acid formation and lower its blood levels are weight control and limited alcohol consumption. Uric acid levels also can be reduced slightly by cutting down on foods rich in purines, which are converted to uric acid in the body. Meats and meat extracts, beans, lentils, peas, spinach, asparagus, cauliflower and mushrooms are examples. It is also important to avoid certain drugs -- low doses of aspirin, thiazide diuretics, ethambutol, pyrazinamide and niacin (often used to treat high cholesterol) -- all of which decrease the excretion of uric acid into the urine.

If these measures fail, two classes of medications can reduce uric acid levels. One class includes probenecid and sulfinpyrazone, so-called uricosuric agents, to increase uric acid excretion. They carry the potential risk of producing uric-acid kidney stones and damage to the kidneys by depositing uric acid in kidney tissues. A third drug in this category, allopurinol, lowers uric acid levels by partially blocking the conversion of purines to uric acid. A rash is a fairly common side effect of allopurinol, but it also can rarely cause a severe skin disease called exfoliative dermatitis. Treatment with any of these drugs should be started with a low dose because a rapid fall in uric acid can precipitate an attack of gouty arthritis just as a rise in uric acid can cause an attack.

A second drug strategy uses colchicine, which interferes with the uptake of uric acid crystals by white blood cells.

Since episodes of gouty arthritis may be separated by many years, you probably should not consider taking a drug to lower your uric acid levels unless you have one or two more attacks of gout and are prepared to remain on drug treatment regularly and permanently.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.

Pub Date: 6/04/96

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