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When uric acid attacks MORE ABOUT GOUT

March 29, 2009 1:14 am

One morning four years ago, Stafford County resident Rick Pantaleo woke up and realized that something was wrong with his right foot.

"It had swollen with a bit of pain, but what I noticed was how difficult it was to walk on," Pantaleo said.

He didn't think it could be anything more serious than a plantar wart, but he visited a podiatrist the next day to get it checked out.

Nothing showed up on an X-ray, and the doctor wrapped the foot in gauze and prescribed painkillers. This worked at first, but the condition quickly became more severe.

Pantaleo's foot became swollen, inflamed and too tender to put the slightest pressure on.

"I missed work since I was unable to walk the short distance from the train station to work," he said. "The pain from an attack was so severe that it would literally bring tears to my eyes."

He said he had trouble concentrating "or doing anything remotely normal."

"I felt like an invalid," Pantaleo said.

He went back to his podiatrist, who sent him to see a rheumatologist, a doctor who specializes in arthritis and other conditions of the joints, bones and muscles.

It was there that Pantaleo was diagnosed with gout.

A BURNING PAIN

According to the Mayo Clinic, gout is "a form of arthritis that's characterized by sudden, severe attacks of pain, redness and tenderness in joints."

This complex disorder is caused when urate crystals accumulate around the joints because there is an imbalance of uric acid in the body. It can be caused by the consumption of too many foods high in purines, such as seafood, organ meat and alcohol.

Gout most commonly affects men between the ages of 30 and 55 and women after menopause, said Dr. Avnit Ahuja of Rheumatology Associates of Central Virginia. She said all 10 gout patients she had seen so far this month were male.

"It's a very painful condition; your foot feels like it's on fire," Ahuja said. "People with gout can't go to work, have trouble walking and even getting up to go to the bathroom."

GETTING RELIEF

Rheumatology practices in the Fredericksburg area are quite busy, and patients in general can face waits to get an appointment.

But "If someone calls us and says they have a flare [of gout], we try to see them the same day because we know how uncomfortable they are," Ahuja said.

Once a patient shows up at Ahuja's office, the first thing she does is confirm the diagnosis by drawing out fluid from the joint and searching for urate crystals. Once it's confirmed that the patient has gout, she begins by prescribing a drug called colchicine.

If the patient experiences multiple gouty attacks, she'll also prescribe a long-term medicine called allopurinal.

"Colchicine helps bring down the swelling and the attack, but not the uric acid level. So for the long term, we'll put them on Allopurinal, which decreases purines and therefore uric acid in the body," she said.

Along with medicines, lifestyle changes--like limiting red meat and seafood and lowering alcohol consumption--can help reduce the risk of gout attacks, Ahuja said.

Ahuja said it is very important to prevent attacks because frequent untreated gouty attacks can lead to further complications.

"When you have [a] high uric acid level in blood, it deposits crystals in the joint space, resulting in damage and disfigurement of joints and erosion of bone," she said. "Some people even get kidney stones."

WHAT TRIGGERS IT

The causes of gout can vary, said Dr. Michael Donato, a podiatrist at Rappahannock Foot and Ankle Specialists as well as a spokesperson for the American College of Foot and Ankle Surgeons.

"A person having a crab-fest cookout and a few beers on the weekend--that's the classic way we think of gout, but its not the only way," Donato said.

People always come down with gout because of an imbalance of uric acid in the body, but that imbalance can come from secreting either too much or too little uric acid, Donato said.

Like Ahuja, Donato initially prescribes colchicine for treatment until the swelling goes down. However, he said the drug has some nasty gastrointestinal side effects such as severe nausea and diarrhea.

"Literally, when we prescribe it, we say that a patient should use a certain amount every few hours either until the pain goes away or until they can no longer put up with the gastrointestinal side effects," he said.

For people who can't stand to use colchicine, an alternative treatment is to use large doses of painkillers such as ibuprofen.

Stafford County resident Dave Nestor, who has suffered from gout for five years, said that colchicine is worth taking.

"It gives me terrible side effects, but for the price of curing the pain, I'll take it," Nestor said. "I've had broken bones, and it [gout] feels like that, except the pain is sharper."

ANYONE CAN GET IT

After being diagnosed with gout, Nestor said, his lifestyle has changed.

"Gout attacks used to scare me to death, but now I have a regimen," Nestor said. "I always carry a bottle of Motrin in my lunchbox and wear loose shoes or slippers to work when I think I might have an attack."

He also said he watches what he eats, doesn't drink alcohol and hasn't smoked in more than 15 years.

Still, Nestor said he feels criticized for having the disease. Gout was once called "the disease of kings" because it usually affected the overindulgent wealthy. Because of the modern diet, gout can now affect anyone, Donato and Ahuja said.

"There's all these bad connotations to it, like you must be fat or a slob to get gout, but that's not how it is anymore," said Nestor. "I mean, I eat well, I'm losing weight, and I drink lots of water. It's just a buildup of uric acid, something anyone can get."

Lauren Orsini: 540/374-5000, ext. 5617;
Email: lorsini@freelancestar.com