Gout Dial A Doc

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With Dr. Bell

Tuesday July 19th, 2016

Members of the CreakyJoints community with gout had the opportunity to learn and ask questions about gout symptoms, treatment and outcomes with Dr. Bell from Charleston, South Carolina. Below are highlights from the call.


 

What is Gout?

  • Gout is a type of arthritis characterized by having a high level of uric acid in the blood. Uric acid is a chemical that can form needle-like hard crystal deposits in the joints.

 

How does Gout present? What are the signs and symptoms?

  • Acute gout can present in any joint with intense pain, severe swelling, most commonly the big toe. Severe pain is the main symptom patients need to be aware of.

 

What can lead to a Gout attack?

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  • Red meat, alcohol and shellfish, are common triggers. Learn more about foods to eat and avoid: Gout Diet
  • Obesity can be a factor
  • We often see gout in people with hypertension.
    • A blood pressure medication (diuretic/water pill) can make gout worse or precipitate an attack.
    • Sometimes this medication dose must be lowered or changed and in some cases discontinued.

 

How do we (doctors) make the diagnosis?

 

  • Observing patient’s signs and symptoms. Link symptoms: Gout Symptoms
  • More detailed diagnosis can be made by drawing blood from the patient and looking at uric acid levels
  • You can also do an arthrocentesis by putting a needle in a joint, pulling out some fluid, looking at the crystals in the fluid to see the shape of them. This is very painful and frightening and usually is avoided.
  • In short diagnosis is usually made by observation, medical history, and the signs the patient presents with.

 

Who gets gout?

  • We usually see gout in patients above fifty
  • This is changing because of the rising level of obesity in the US; we can now see attacks in people under 45
  • We also see gout in women as frequently as men although this did not used to be true.
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Question: Tom, from Seattle-

Tom never had a problem until recently. He is 68 and not overweight, stopped drinking beer and wants to know what is behind his gout attacks.

Listen:

NOTE: Some people can have hyperuricemia for months or years without issues, others can have it and begin to develop significant problems. For acute attacks go to a primary care physician, if that is not possible then go to the ER.

 

Treatment

Learn about gout treatments: Gout Treatment

 

TIP: The most important thing to remember is to take the medication your doctor prescribes on a chronic level because once these stops uric acid levels can build up again and cause a flare.

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Comorbidities and Systematic Impact of Gout

  • Can fill up kidneys in the form of kidney stones and cause chronic renal failure
  • Can also affect the heart à can cause atrial fibrillation which is an electro cardiac condition that can lead to a stroke or heart attack
  • Can affect a person’s vision via the eyelids, lenses, cornea, and conjunctiva
    • Need to be seen by your ophthalmologist in this case

Other blood work that should be taken:

  • Kidney function
  • Liver function (allopurinol can cause abnormal liver function)
  • CBC (a blood test to check hemoglobin and hematocrit)

Now that you are educated, you should request that your doctor runs these tests, because a doctor may forget. You do not want to be walking around with a high uric acid level because that alone can cause problems even without symptoms.

 

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Question from email: Can gout affect the immune system? Can a cold cause a gout attack?

  • Probably not, but we are looking at a disease we are finding much more about as time progresses. No for right now, but that answer might change with more research.

 

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Question from email:  “I am a 62 year old male, I had my first gout attack a month ago when I sprained my ankle. My gout impacted both feet in my big toes. My gout remains with tingling and pain in my toes and had uric acid levels at 6.2 and taking allopurinol daily”

  • A gout attack can be caused by having an acute injury to the affected joint
  • Either he is not on enough allopurinol or he was not taking the medication as he was supposed to
  • The patient must go back to the doctor, who may make a decision to put him on another medication

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When you have been following these directions and your uric acid levels are still up, then go to a rheumatologist. They are specialists and may no more information that a PCP might not know.

 

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Question: Can asparagus, artichokes, mushrooms, and spinach cause gout attacks?

  • These are vegetables high in purines. There is literature that says the health benefits that these give neutralize the health risk of higher purine levels. It is safe to eat, but you should talk to your doctor if you are concerned.
  • Also, we all are individuals. If you find that eating this can precipitate an attack for you, then you must eliminate it.

Thank you to Dr. Bell for taking the time to speak with us. Our participants learned a great deal, and appreciated the session. In one participant’s own words:


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Dr. Bell Bio:

dr bellDr. Bell went to the University of South Carolina and completed his residency at Richland Hospital in Columbia South Carolina. He has been a family practice doctor for over 36 years in North Charleston. If you live in the Charleston area you can hear Dr. Bell on local television and radio where he shares health related information. Dr. Bell is also the founder of Closing the Gap in Healthcare a nonprofit aimed at ending health disparities.

To learn more about Dr. Bell and his work please visit: closingthegapinhealthcare.org