Gout

[curiosity]

My other half is suffering his first ever attack of gout in a big toe he injured and badly bruised a year ago. The GP offered him tablets for life. But he has declined as he wants to see when or if he will get another attack, to work out how much he needs to do, to prevent it. What things trigger your gout, dietary or other? and what herbal or home remedies are there other than tablets for life?

Any help, anecdotes or other appreciated.
Many Thanks

[gasworks]

make a lubricant of 6drops of Pimento oil (berries) in comfrey oil as the carrier 10ml.

Rub the toe with this at least twice a day, once being before retiring at night.

[curiosity]

Thanks, is that to treat an attack or prevent? and where do you get it from gasworks?

[jno]

I'm on the tablets for life, and they seem to have no side-effects (allo-purinol). But I waited quite a few years, and several attacks, before agreeing to them, and I'd suggest your other half does the same. It might prove to have been a one-off. I've never found what triggers it - most of the danger foods are ones I never eat - and though the pills work, touch wood, nothing else did.

[figure]

I read somewhere that high caloric foods causes gout.

[theprof]

He's better off treating the gout symptomatically when each of the "attacks" occurs. This is the policy adopted by most GP's nowadays.

The usual treatment given by the GP is a NSAID (non-steroidal anti-inflammatory drug). GP's have their own personal preference over which drug to select but normally the favourite is Indomethacin at a dose of up to 200mg daily. Ibuprofen, the only over the counter NSAID apart from aspirin is not so effective.

Allopurinol needs to be given in the interval between acute gout attacks as it works by inhibiting the action of an enzyme called xanthine-oxidase which is involved in the production of uric acid. It's a high serum accumulation of this uric acid that causes the gout.

GP's can be a bit cautious about prescribing allopurinol as it sometimes causes rashes and you need a pretty high fluid intake each day to avoid crystals forming in the urine. It will also make a gout attack worse if given during the attack and also can't be given within a month of stopping an NSAID. Having said that, it should keep him gout free for the rest of his life if taken regularly.

[theprof]

It's not so much high calorific value foods that cause gout as food that contain high levels of purines.

Purines are nitrogenous bases such as adenine and guanine, required by the body for the formation of nucleosides, nucleotides and nucleic acids. Foods high in purines such as anchovies, asparagus, herring, meat gravies, sardines, mushrooms, most organ meats, mussels and other shellfish etc result in an over production of uric acid which the kidneys cannot all eliminate in the urine. The excess uric acid in the blood causes urate salts to be deposited in the joints and this causes the excruciating pain and swelling.

Sometimes though purines are not responsible. Gout can arise as a result of taking certain prescribed drugs, kidney disease, leukemia or by certain enzyme disorders in the body.

Avoiding alcohol helps an attack subside quicker.

[slipnot]

Hate to be a killjoy but you're supposed to abstain from alcohol and spicy foods (i.e. curries)!

[jno]

I took indomethacin during attacks for a while; it worked but it gave me appalling headaches - worse than the gout. And vioxx, but that was banned. And symptomatic treatment is out when you can't see your GP without making an appointment a week ahead (as I can't). So I will take the allopurinol till the end of my days and hope it continues to work as well as it's doing now.

[Loosehead]

I once injured my toe playing squash and it just would not go away, it kept coming back so I went to the doc and he said it was gout, I had visions of old guys swilling port with a huge bandage on he foot! I was a fit 27! I initially didn't believe it and refused to take pills. I started getting it in other joints, elbow for example, during an attack I was given Diclofenac Sodium and it worked wonders. I was initially reluctant to start taking allopurinol daily but I did some studies and found that repeated attacs can cause full blown athritis and cause deformed joints. So I've been on allopurinol for 18 years and not had a problem. It is possible by careful diet, no boozing etc to be gout free but taking a pill each day is a lot easier. oh Cherries are good for gout!

[jno]

Some attacks are painful beyond belief but it's worth pointing out that some aren't so bad - too sore to walk on but not bad enough to keep you up all night. Others are, however; I've had a couple that didn't respond to painkillers for days. Hence the allopurinol. But it's worth waiting, as I said, to see if it happens again; it may not.

Loosehead, do you mean cherries (to which I am partial) prevent or cure gout, or cause it?

[theprof]

jno, if you've got a sympathetic GP and have had Indomethacin previously, you should be able to get a script for the tablets by picking up the phone. Get the local pharmacist to dispense and deliver the. Most GP's understand nowadays that most patients are immobile when they've got Gout. If the GP refuses, it's time to seek another practice. My dad uses this method with no problems.

knobbynonut, Zyloric is just a branded version of Allopurinol at around ten times the cost to the NHS. My dad gets the gout in his big toe, but a bloke I work with gets it in his elbows instead. You can have it in any joint in the body.

Loosehead, Diclofenac Sodium belongs to the same group of drugs as Indomethacin and is just as good for symptomatic relief. It's down to the personal preference of the GP.

My teenage son asked me to show him some self-defence a few weeks back (he sustained a single punch from a Strongbow drinking yob on a train). I accidentally managed to put my full weight on the big toe of my right foot for a second during the lesson. My big toe was black within hours. The damage combined with the fact that it can be hereditary in some people makes me think I'm a dead cert for the gout in a few years time!

[Loosehead]

cherries are benificial jno

[curiosity]

Thank you very much all of you, that's been great advice.