We are living in an epidemic of gout arthritis. Almost 10 million people in the United States have high uric acid and gout. Often, we think of gout affecting men who drink too much alcohol and eat too much. This has changed. Many postmenopausal women have gout. Why?
A significant cause is that many men and women today are overweight, have high blood pressure, high cholesterol and diabetes. The presence of a high uric acid (greater than 6 mg.) occurs very often with all of these conditions and make their treatment more difficult.
Over years high uric acid in the blood spills into the joints and leads to Gout which causes severe pain and swelling of joints. We can remove fluid from a painful joint and see crystals of uric acid under a microscope. (See the photo page.)
Musculoskeletal ultrasound imaging and DECT scanning are precise studies that can image the layering of uric acid around and in joints.
Treatment of high uric acid and gout always starts with dietary changes to avoid many foods that contain large amounts ofpurines which lead to an excessive burden of uric acid. A change in diet alone may lower the blood uric acid 1 mg but rarely will it affect the re-occurrence of painful attacks of gout.
There are medications available to reduce the frequency and prevent future attacks. One way to think about the burden of uric acid is that patients who do not have gout have a total body uric acid that could be measured in a tablespoon. In contrast, those patients who have had frequent attacks of gout have a salt mine. Treatment is to reduce this overwhelming burden of uric acid. First line medications are Allopurinol and Uloric. The addition of Zurampic to these medications can be helpful also.
Patients with recurrent attacks of gout and those who have deposits of uric acid (tophi) around and in their joints can benefit from the administration of an intravenous medication, Krystexxa. This treatment is very effective and may change the quality of patients’ lives dramatically. (See photo >>)