QUESTION: I was diagnosed with gout when I was 29 and none of the medications seem to help. I have tried them all: Puricos, Allopurinol and colchicine, which has terrible side effects.
Now, when I feel an attack coming on I take three Prednisone, which helps to ward it off. If the pain is really bad I go for a cortisone/voltaren injection.
Now I am getting tophi (crystals of uric acid in the tissues which build up, causing small lumps to form underneath your skin). I have three big ones under the big toe of my left foot.
It was difficult for me to walk until a podiatrist made an insert, which relieved the pain and pressure immensely.
There are some tophi on the joint of my right-hand thumb. I have them on my knees, elbows and one ankle. I had to have surgery in September and during the operation the tophi on my ankle was sliced off and it is taking a long time to heal.
I am using a glycerine mixture, Icthymol, and a homeopathic remedy as well as Bactrim, which seems to be helping slightly. Although there is a “cheesy” substance oozing from the sore which is the size of a bottle top.
I was diagnosed with diabetes (Type II) three years ago and my weight dropped from 82kg to 57kg. The only medication I take for my diabetes is Glucophage 1 000mg twice a day, and Vectoryl 8mg once a day for hypertension
My diabetes and high blood pressure are under control and I follow a moderate diet – no fizzy drinks and the occasional chocolate.
The doctors could find no explanation for my weight loss, despite a colonoscopy.
The question is, what can I do about the tofi and how can I speed up the healing?
ANSWER: You mention being diagnosed at the age of 29. I hope the diagnosis was accurate and that all steps were taken to investigate properly. Poor wound healing is well known in diabetics due to the vascular complication and venous stasis.
The cheesy substance you describe could be pus and indicate a secondary infection and should be examined by a professional.
This contributes to poor wound healing.
As a chronic gout sufferer it is crucial to understand the difference between gout emergency treatment and preventative treatment.
The medical treatment is only one aspect of care. Diet and lifestyle issues have been proven to be just as important.
Chronic gout leads to extensive tophi and chronic arthritis – this is permanent mechanical damage to the joints.
Gout is simply a clinical syndrome related to raised uric acid levels.
There are multiple contributory causes of raised uric acid levels and that Syndrome X or the Metabolic syndrome, which includes hypertension, diabetes, dyslipidaemias and gout, are equally harmful to your health.
The increase in gout is believed to be due to metabolic syndrome, longer life expectancy and changes in diet.
Gout was historically known as “the disease of kings” or “rich man’s disease”.
Long-standing elevated uric acid levels (hyperuricemia) may result in other symptomatology, including hard, painless deposits of uric acid crystals known as tophi.
Extensive tophi may lead to chronic arthritis due to bone erosion. Elevated levels of uric acid may also lead to crystals precipitating in the kidneys, resulting in stone formation and kidney stones.
How does gout present?
* Usually attacks of acute inflammatory arthritis. Acute onset of red, tender, hot, swollen joints.
* The joint at the base of the big toe is affected most often, accounting for half of cases. Other joints include heels, knees, wrists and fingers.
* Joint pain usually at night, due to the lower body temperature.
* Fatigue and a high fever can sometimes accompany gout.
How is the diagnosis made ?
Blood serum test for uric acid levels and synovial fluid analysis to demonstrate gout crystals. X-rays are only useful in chronic gout.
Drugs that contribute to gout:
* Diuretics
* Niacin
* Aspirin (acetylsalicylic acid)
* Immunosuppressive drugs: cyclosporin and tacrolimus
Prevention:
* Diet – reduce intake of meat and seafood .
* Adequate vitamin C. Intake of 1 500mg a day decreases the risk of gout by 45 percent.
* Limiting alcohol and fructose.
* Avoiding obesity.
* Gout may be secondary to sleep apnoea via the release of purines from oxygen-starved cells. Treatment of apnoea can lessen the occurrence of attacks.
From painkillers to cherries
Nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, or colchicine improve symptoms. Once the acute attack subsides, levels of uric acid are usually lowered via lifestyle changes, and in those with frequent attacks, allopurinol or probenecid provide long-term prevention.
Glucocorticoids have been found as effective as NSAIDs. They also lead to improvement when injected into the joint.
Natural remedies: People have found relief from gout pain by eating one tablespoon of celery seeds a day. Celery seed oil, a significant source of sedanolide, is used as a herbal remedy to treat inflammatory-associated conditions such as gout and rheumatism.
The internet is full of advertisements for alternative treatments. The herbal remedies include cherries, cherry extracts, cherry juice, celery seed, celery extract, cider vinegar, milk thistle, turmeric (curcumin), artichoke extract, garlic, Yucca schidigera, and various Chinese herbs.
There is little chance that cherries or any herbal products will be tested for effectiveness to satisfy the FDA requirements since pharmaceutical companies have no financial incentive to scientifically test cures using natural products for which they do not have exclusive marketing rights through patents or trade marks. – www.scientificpsychic.com/health/gout.html.
* Dr Darren Green, a trusted figure in the field of media medicine, is a University of Stellenbosch graduate who adds innovative spark to health and wellness issues.
He features on 567CapeTalk, and is a regular guest on SABC3 and the Expresso show. Dr Green works as an emergency medical practitioner at a leading Cape Town hospital and completed four years of training as a registrar in the specialisation of neurology.
If you’ve got medical problems, contact the doctor at [email protected], 021 930 0655 or Twitter @drdarrengreen. Catch him in Cape Town on 567 CapeTalk, most Fridays at 1.30pm.
The advice in this column does not replace a consultation and clinical evaluation with a doctor.
Cape Argus