Reviewed by Carol DerSarkissian on April 25, 2016
Edward Dwyer, MD Assistant Professor of Clinical Medicine/ Fellowship Director Division of RheumatologyDepartment of Medicine,Columbia University/New York Presbyterian Hospital
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Edward Dwyer, MD: Yeah, I remember when you were first here there was some swelling. That seems to have gone completely now…
Shaun Hill: I thought I injured my foot. And I went to several doctors. I thought it was a broken foot, I thought it was a sprain. I twisted my ankle, anything…
Edward Dwyer, MD: There are several triggers: one is well described, and that is actually trauma to the joint, for example, stubbing your toe will actually cause a gout attack in that toe. It's very common after surgical procedures, not necessarily on the foot or toe, but any surgical procedure that you can develop an acute gout attack. One of the primary recommendations for initial treatment of high blood pressure is a diuretic—a water pill called hydrochlorothiazide and taking hydrochlorothiazide actually has the untoward effect of elevating your uric acid as well. And would that be considered a trigger in and of itself then?
Edward Dwyer, MD: Certainly that can be a trigger and has been well described as a trigger in terms of inducing acute gout attacks. And then there's the more wide-open diet issue in terms of dietary sources that are rich in purines… Purines are one of the building blocks of our nucleic acids, so when we break those entities down, one of the products is uric acid. The foodstuffs that are typically rich in purines are organ meats such as liver, red meats, shell fish, various vegetables that are high in protein, for example beans. And then there's the alcohol ingestion which is also known to be associated with acute gout attacks, particularly beer because of the high protein content in the beer. There is a known association between obesity and the development of gout. I would say primarily perhaps to limit yourself to diets that are low in purines, low fat and also exercise to keep your body mass at an appropriate level. Low fat dairy products are an appropriate source of protein and there are constituents in dairy products that are thought to actually reduce the level of uric acid in your blood. How important is just maintaining proper hydration?
Edward Dwyer, MD: It's quite important for two reasons really. Number one to keep your body well hydrated obviously will lower the concentration of uric acid in your blood and your body tissues. Those who have elevated uric acid are more prone to kidney stones. So the hydration's important to prevent the gout attacks and also is important in reducing the frequency of kidney stones from uric acid precipitation in the urine.