[Noah930]

Gout is pretty much an inborn error in metabolism. You've likely inherited the problem from your parents. Your body doesn't break down certain proteins as well as it should. So uric acid accumulates in your blood. Sometimes the acid crystals will precipitate out of your bloodstream, and they accumulate in joints. Particularly the metatarsophalangeal joint at the base of the big toe. That's called podagra. The joint becomes painful and swollen. Typically you can't even stand the pressure of bedsheets covering that toe, at night. However, gout can develop in any joint.

In my experience, both personal (moderately extensive) and professional (scant, as I don't see much gout as a hand surgeon), blood tests aren't necessarily that useful. Well, they seem to be more useful in textbooks than they do in real practice. I've found very few internists and rheumatologists to be interested in a patient's uric acid level. They only seem to order uric acid levels as an afterthought. A part of the textbook workup is to order a 24-hour urine collection (to help discriminate between over-producers and under-excreters, IIRC). I've never seen anyone do that. Finally, the definitive test for an acute attack is to aspirate (suck out) some fluid from the offending joint (though good luck approaching anyone with a needle when they've got gout), and looking at the aspirate under polarized light. There are characteristic negatively birefringent crystals to be seen. Only medical students do that.

People seem to make a big deal about diet. Personally, my gouty attacks don't seem to have much relationship with what I eat or drink. But typically it's alcohol and red meat that are villified. Asparagus seems to be related, too. Staying hydrated seems to be key. I've blunted many attacks of gout by just drinking and drinking water. My wife notices that I seem to have more attacks when I'm stressed. There's probably some cortisol/hormonal relationship.

Oral anti-inflammatories are usually prescribed for an acute (active) attack of gout. Things like Motrin/ibuprofen and Indocin/indomethacin. On paper, they're interchangable. Indocin usually is considered stronger. Personally, ibuprofen works, but indocin doesn't. Go figure. Not recommended due to liver and GI side effects, but I lived on 800 mg of motrin three times per day for 7 straight weeks, once.

Colchicine is also used. You're supposed to take a tablet every two hours until the pain goes away. Or until you can't tolerate the side effects. It's main side effect is diarrhea. Not a good side effect for a surgeon, plus it doesn't seem to do much for me, personally.

Tobra recommended to me cherry juice. I've tried that, and it's seemed to help me a little bit. $4 a bottle at Trader Joe's.

And the best treatment I've found has been an intra-articular steroid injection. Essentially a cortisone injection. It works as a concentrated dose of anti-inflammatory medication delivered to exactly where it's needed (as opposed to oral pills that go throughout your bloodstream). The standard party line is that it takes 3 or 4 days before the steroid starts to do its thing. However, my wife (a nurse) gave me the injection once, and I have to confess that the stuff worked virtually immediately. INCREDIBLE. Again, you'll be petrified at someone approaching your throbbing big toe with a needle. But the payoff is ridiculously worth it. The next time I had gout (this time in my ankle), the wife was out of town and wouldn't be back for several days. I couldn't bear any weight on my foot, the ankle throbbed so much. So, on a Sunday afternoon I gave myself the injection. This time it took 2 days to take full effect, but at least I didn't miss any work.

Once you've settled an acute attack, you can ask your physician if you should be on a regular medication (Allopurinol) to control your uric acid levels to avoid future attacks. Allopurinol is not to be used for an acute attack, as there is evidence that it may actually prolong an acute attack. I'm not on it (maybe I should be?), but several family members who are swear by it. Far fewer attacks, and when they present, they're much less severe.