If you have recurrent pain and swelling behind your big toe or in your ear,
you may have gout.
Gout occurs when uric acid crystals precipitate out from your joint fluid to
cause pain, swelling and heat. The only way to prove that a hot painful
joint is caused by gout is for the doctor to remove joint fluid and to see
crystals in it under the microscope. Attacks of gout can be precipitated by
being overweight, having a tumor, exercising for a long period of time,
taking in large amounts of fructose in special fruit drinks, drinking
alcohol, particularly beer, eating large amounts of purine-containing foods,
or taking aspirin, diuretics or large doses of the vitamin, niacin.
Doctors usually treat painful attacks of gout with aspirin or non steroidal
pain medications, such as indomethacin. After the pain is gone, doctors
usually prescribe allopurinol to reduce the amount of uric acid manufactured
by cells, and probenecid or sulfinpyrazone to draw uric acid out through the
kidneys. Probenecid should not be prescribed to people whose livers make too
much uric acid because it will cause kidney stones. Your doctor should ask
you to provide a 24-hour urine specimen and check it for total uric acid.
If levels are high, you should take only allopurinol and not probenecid.
Doctors usually do not recommend low purine diets to lower uric acid because
drugs are so much more effective. High-purine foods include meats,
particularly organ meats and seafood, meat extracts and gravies, yeast, beer
and other alcoholic drinks, beans, peas, lentils, oatmeal, spinach,
asparagus, cauliflower and mushrooms. A low-purine diet includes refined
cereals and white flour, milk and dairy products, butter, margarine and
other fats, fruits, nuts and peanut butter, lettuce, tomatoes and green
vegetables, cream soups made without meat and low-purine vegetables, water,
fruit juices and carbonated drinks
By Gabe Mirkin, M.D., for CBS Radio News