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Gout

Gout remains the most common inflammatory arthritis in America far surpassing the more widely recognized rheumatoid arthritis. At least 8 million individuals suffer with this complication of elevated serum uric acid. Interestingly the majority of people with hyperuricemia will never experience gout and are better left untreated. In gout, the uric acid gains access to the joints, crystallizes as monosodium urate and is engulfed by resident white blood cells. The ensuing inflammatory reaction leads to agony typically on the inner aspect of the large toe in the same location where a bunion would appear. Often the individual retires for the evening perfectly healthy only to awaken in the middle of the night with an exquisitely tender, red, hot and swollen joint. Surprisingly treating the acute symptoms of gout or podagra with a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen, naproxen or diclofenac provides similar relief to the previously more popular but often quite toxic colchicine. Within one year of the first gout attack the recurrence rate approximates 60%. People with more than one gout attack a year probably should consider ongoing treatment with allopurinol to lower the serum uric acid level to 6 mg/dl. This minimizes the risk of further damage to the joints and kidneys.