By David Mandel, MD
Putting off any health issue will only make it worse. When one has gout arthritis, it is no different.
I’ve seen patients with recurrent gout put off proper care for so long that they have to wear a larger shoe size, cut a hole in their shoe or not wear closed-toes shoes at all because of hard nodules – ‘tophi’ – on their toes. One patient of mine had to drop out of his bowling league due to tophi on his fingers.
You see, gout’s debilitating attacks force people to seek care quickly. Too often, people think they are free and clear after the attack subsides. They are wrong. Gout is caused by a buildup of uric acid that can occur in between the acute attacks and will lead to tophi. These are uncomfortable, and can destroy joints. High uric acid levels can also cause long-term damage to the heart and kidneys.
Many people look for a quick fix to treat the acute attack of gout. They think they can drink less beer or diet soda to relive their gout. These beliefs are often due to misinformation or old wives’ tales. Watching your diet can help in some cases, but diet alone won’t normalize one’s uric acid level for the long term.
Instead, I tell people that managing one’s gout should be like managing one’s blood pressure. You can’t address blood pressure only when it’s high. Neither can you address it with one-off dietary changes. Instead, patients take medicine daily to maintain a lower, safer blood pressure. Failure to keep one’s blood pressure normalized can lead to heart attack or stroke. Likewise, failure to keep one’s uric acid levels normalized at 6mg or less can lead to painful gout attacks and the buildup of tophi. Oral medications such as allopurinol or febuxostat taken daily are a first step.
The impact of having the pain and anguish of acute gout arthritis and the disfigurement of tophi, and the power of treatment, can scarcely be overemphasized. I’ve had patients lose their livelihood because of uncontrolled gout. I think of one patient who was a mechanic and had to quit because he could no longer safely handle tools. For serious cases like these, I prescribe intravenous therapy. I like to think of it as Drano for your blood and joints. It’s a remarkably efficient way to resolve tophi and give people their life back.
For example, I saw a patient this month who had great success with intravenous therapy. Prior to using it, she tried oral medicines, but was still having reoccurring gout attacks in her wrist, knee and foot. As a teacher, the gout left her unable to stand for long periods, so she was missing lots of school. She finally made the commitment to get intravenous therapy with pegloticase. This is administered twice a month as an outpatient. After just a couple infusions, the frequency of attacks have greatly diminished. She feels like she’s gotten her life back, she tells me.
As a seasoned rheumatologist, I share these examples to encourage those who are newly experiencing or who have had recurrent gout to get treatment right away. Don’t wait until your back is against the wall. There’s no reason to jeopardize your health or live in misery when gout can effectively be treated.
David Mandel, MD, a rheumatologist in northeast Ohio, is a member of the Alliance for Gout Awareness.
