Berkshire Senior Online

Homepage -- Programs and Services -- Contact Information

 2000 Monthly News
December

Gout is more than a rich man’s disease!!
State awards Long Term Care Ombudsman recognition
Dear Reader:
Elder Services Hails Older Americans Act Reauthorization
From the Director
It’s storming! Will my meal be delivered?

Gout is more than a rich man’s disease!!

By Jonathan D. Krant, M.D., M.P.H., F.A.C.P.

Gout is an inflammatory form of arthritis brought about by the deposition of uric acid in the joint space. Of all the many inflammatory forms of arthritis, gout has by far the most notorious history; in days of old it was commonly associated with consumption of organ meats and drinking to excess (both habits afforded only by the wealthy). Hogan’s famous depiction of this "rich man’s disease" was a series of woodblock prints and images of nobility beset by devils tearing at their feet and ankles. We now know that gouty arthritis occurs regardless of class, food predilection or phases of the moon, although certain patterns of behavior and medication may certainly make established gout worse for patients.

In the acute flare state, patients with gout describe severe, lancinating pain affecting the first metatarsal joint of the foot (big toe) although arch, knee, wrist and finger involvement are not infrequent. Left untreated, the acute flare will often resolve within 3 to 5 days; however, the period between acute attacks (the intercritical period) will diminish with the passage of time. Consumption of organ meats, alcohol and the use of diuretic medications are clear-cut risk factors, although family history, excessive local trauma to one joint in the genetically at risk patient and very high serum concentration of uric acid also contribute to patient risk of acute flare.

Treatment options are multiple, but begin at home with avoidance of organ meats, anchovies, chocolates, wine and cheese. Nonsteroidal anti-inflammatory medications (ibuprofen, indomethacin, aspirin) provide both analgesia and anti-inflammatory effects in the acute flare state, as does prednisone in moderately high doses, with a rapid taper in dosage. Drugs which assist with the excretion of uric acid (allopurinol, probenedid) and drugs which inhibit the formation of uric acid (allopurinol, oxypurinol) are also highly valuable agents in the management of chronic gout. Goals of therapy are to increase urinary excretion in patients with normal kidney function, while inhibiting the formation of uric acid crystals. Perhaps 90% of patients are relative under-excretors of uric acid, while only 10 percent produce too much, often associated with medications used for cancer chemotherapy or certain rare metabolic conditions. In the new millenium, aggressive control of pain and reduction in concentration of uric acid are both possible and highly beneficial for patients with gout.