Up to now, we’ve talked about what causes gout and things that people most often mistake for gout. The obvious question is, “How is gout treated?” There are multiple factors to consider. The first is diet. An extensive internet search can be very confusing. If you look long enough, basically everything causes gout! What food should you be aware of? As a rule of thumb, avoid anything high in purines. Red meat, organ or glandular meat, seafood/shellfish, red wine/alcohol, and some studies include coffee/caffeine. On the flip side, stay well hydrated. Drink plenty of water. Some studies show that vitamin C and cherries can also help with uric acid levels.
Medical treatment usually starts with NSAIDs such as Ibuprofen to decrease the amount of swelling. Be careful applying ice to the area. If you consider the physiology of a gout flare (uric acid crystals forming because of a cool joint), ice may only exacerbate the condition. My patients have found relief with a warm compress to the area. Physicians will often use medications like Indocin or Colchicine to help with inflammation. Corticosteroids such as Prednisone may also be used. When that fails, a steroid injection directly into the joint may help as well.
Another treatment method is to limit the amount of uric acid your body produces. This can be done with medications like Probenecid and Allopurinol. The downside to these medications is, unlike the medications used for treating acute gout flare, these medications are taken every day.
When all else fails, the patient has two options. The first is a consult with a Rheumatologist for further treatment options. The second option available to some is surgery. Multiple gout attacks on one particular joint will often destroy the joint and cause further inflammation and irritation. Certain joints in the foot can be fused to relieve the pain and gout attacks in that particular joint. However, that is no guarantee that gout will not appear in another joint.
The way to avoid all this is early, aggressive treatment. As a podiatrist, I see lots of gout and most of it is easily treatable. Hydration, diet control, and weight control are highly effective in gout control and are things that we all can do.
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By Jonathan Williamson, DPM