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Dr. Zorba Paster: Drugs can offer help for gout

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Dear Dr. Zorba: I am 45 years old and have been having occasional acute gout attacks for the past three years. They occur about four to five times a year. They’re miserable.

I’ve been prescribed indomethacin to reduce swelling during the attacks. All of the past attacks have been in the ball joints of my feet and toes and will just cripple me for three to five days.

I’ve researched cause, prevention and treatment options with very vague results. Lots of home remedies like drinking baking soda and cherry concentrate. Yuck!

Or stop eating lobster, shrimp and liver — but I rarely eat seafood and I never, ever eat liver. I did stop drinking beer and soda, which does seem to help a bit but doesn’t stop it.

The pain during an attack is so bad I’ve joked I would rather just cut off my toes. There is no relief, soaking, icing, elevating nothing. I can’t sleep. I can’t drive. I can’t function. The only thing that gives me any relief is the indomethacin and that upsets my stomach.

Is there a shot or some kind of dialysis that could remove or neutralize the uric acid crystals in the joints during an attack? I know there are prescription pills, but that’s a life sentence. Help! — R.P., from Utah

Dear R.P.: Gout is awful. Awful. Awful. You’re in good company — Ben Franklin, Thomas Jefferson, Henry VIII, Louis IV all suffered from “the rich man’s disease,” so named because of its association with shellfish.

Gout is more common in men than women, but after menopause women start to get it at the same rate. Estrogen must be protective. It comes from either producing too much uric acid or under excreting it.

But here’s the rub: Some people with high levels of uric acid never get gout. And we don’t know exactly why.

Diet can help — avoiding foods high in purine such as red meat, liver, seafood, lobster and high purine veggies such as asparagus and spinach. Beer, liquor and sugary soda also seem to trigger it.

One natural thing that might offer protection is including 500 to 1,000 milligrams a day of vitamin C in your diet. Cherries also might help, and believe it or not, drinking more coffee (hurray!).

But frankly, if you have flare-ups like you describe, the best treatment is to lower blood uric acid with the generic prescription drug allopurinol. It’s cheap; a typical three-month supply will run you about $20.

This drug was a game changer when it was invented in the 1950s. All of a sudden, people with gout could function. They became flare-up free as long as they took it every day.

That’s why I recommend it for people who suffer gout attacks often, with the guidelines for use based on how common and painful their flare-ups are. And if allopurinol doesn’t work, then consider the more expensive uric acid drug febuxostat. (Full disclosure: I researched the drug for Takeda Pharmaceutical Co.)

Now, if you do have a gout attack, you have three choices. First off, any NSAID works, not just indomethacin, so try other nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen.

I tell patients to take over-the-counter ibuprofen or naproxen at twice the dose indicated on the bottle. That’s 800 milligrams of ibuprofen three times daily or 440 milligrams of naproxen twice daily. Take it until the flare-up abates. The nice thing about taking over the counter NSAIDs is that their always available. No need for a doctor’s prescription. And if that flare occurs when you’re away from home, as many gout flares do, you just drop into a convenience store and pop the pills. The sooner you take them the better you are. Other treatments are prescription ones such as colchicine, or a course of steroids.

My spin: You may think that taking a pill is a life sentence but having lot of gout flares is a worse life sentence by far.

This column provides general health information. Always consult your personal health care provider about concerns. No ongoing relationship of any sort is implied or offered by Dr. Paster to people submitting questions. Any opinions expressed by Dr. Paster in his columns are personal and are not meant to represent or reflect the views of SSM Health.


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