Ask Dr.Swiner: Gout and Arthritis

I was raised in the South, and I can recall a distinct memory early on in medical school that inspired my topic for this article. I’ve also recently seen a lot of people suffering with this particular ailment.

During my fourth year of medical school, a gentleman in a VA hospital was telling me about his painful foot. “I got the gouch, doc!”, he said.

I knew exactly what he meant, because I’d heard this described before by relatives, friends and other patients that I had encountered. It makes perfect sense doesn’t it? It sounds just like it feels – like an ouch.

Gout is a horribly painful joint disease that affects many people. It gets to the point where patients don’t want bed sheets or socks or a strong gust of air to touch or blow their way for fear of increased pain.

Over the summer, I saw an increasing number of patients with it, and it sparked my curiosity. So I went to research a little bit deeper than what I already knew about it.

Regular osteoarthritis is a condition that affects the joints from cartilage or cushion lost in between joints. You can also imagine it as an exaggeration where one loses the joint fluid in between the joints, so there is more bone-on-bone contact. It reminds me of the Tin Man from The Wizard of Oz who could barely move without oil in his joints.

Rheumatoid arthritis is an autoimmune disease where the body essentially attacks its own joints with antibodies. This is mostly on both sides of the body. In medical school, the picture I always remember is that of a pair of hands with fingers leaning toward the pinky.

So what do we use for prevention of these things? For gout, we talk about those that are over-producers or under-secretors of the acid. Interestingly, 90 percent of patients are under-secretors, meaning they don’t eliminate it well from the body. This is usually due to one’s genetic makeup or chronic kidney disease. The objective in helping this is to help the patient urinate it out better. We have medicines such as Allopurinol or Uloric that can help.

For those few that are overproducers, we should reduce the intake of purine or uric acid-producing foods. These rich foods include things like seafood, beef and alcohol, hence the nickname of gout as the “rich man’s disease. There are some reports of certain natural supplements or foods that can help with preventing gouty flares, such as cherry juice, ginger or turmeric root. I’ve had some patients swear by these things.

What I learned recently at a conference is there may be a link between uric acid and heart and artery disease. It makes sense if you think about it. The same way the acid crystals can attack and clog joints is the same way crystals could attack and clog arteries. Also, men generally get gout in their big toes, and women get it in their wrists and ankles for some reason.

With treatment, we can either prescribe pain medications like Ibuprofen or Indomethacin, steroids, or uric acid-specific meds like Colchicine and Allopurinol. The key, though, is to start treatment fast and stay the course. Stay on your medicine until your uric acid level is less than six. Follow the right diet. Don’t stop or change your meds before contacting your doctor, because it could cause a flare.

Be healthy and be blessed. Happy holidays.

Dr. C. Nicole Swiner works at Durham Family Medicine, where she treats newborns to elderly patients. She can be reached at www.durhamfamilymedicine.net.

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