Talk:Gout

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Contents 1 References to reference 2 Diet Soda? 3 Diagnostic Confusion 4 Extra-articular effects 5 Overindulgence 6 Alcohol 7 Tea 8 Famous people 9 Genetics 10 Great article but Needs image 11 Celery, cherries, strawberries, blueberries: citations 12 Modern commonality 13 Galen 14 Fructose 15 Podagra? 16 Inconsistency with regard to spinach 17 Added to Prevention 18 T-Rex with gout 19 Blood pH and bicarbonate as a remedy 20 Removed - probable vandalism

[edit] References to reference

One of the references in this article, Abrams B. Gout Is an Indicator of Sleep Apnea Journal SLEEP 28(2), Feb 2005, p. 275., is to an article that is not freely available on the web. That author has written two related articles that are freely available covering the same material. I am not certain if it would be appropriate to link to them in the main article or not. They are not as formal as the article in SLEEP. They Are: Curing Gout: a Personal Journey of Discovery and Burton Abrams Follows Up on Sleep Apnea and Gout

I have lifted the dietary recommendation from the page in French and translated them with a free translation service ( hence the poor grammar) but some recommendaitons clearly contradict the page in English. Particularly Tuna and salmon are recommended while the English version says to avoid fish. Does this imply the pysiologies of diefferent language speakers are different? What about bilingual people?

"The dietary system is encouraged with a food poor in purines: --129.96.142.21 04:29, 26 June 2006 (UTC) Avoid the offals, the anchovies, the bouillons, the seafood, the asparagus, the spinach, the legumes. Consume preferably: cherries, celery, strawberries, cornflowers, weak dairy products in fat, bread (without white flour), tuna, salmon. An slimming is desirable as well as a significant decrease of the taken one of alcohol.

---

[edit] Diet Soda?

It says in the article diet soda should be avoided because it acts as a diuretic. But so does any drink that contains caffeine. And some diet sodas are caffeine-free. There's no citation for the claim that diet soda in particular is bad for gout, so unless one is added within the next few days (and not from some crackpot's (i.e. Joseph Mercola) web page, I'm removing the statement.

I haven't looked up a reference for you, but diet soda is a diuretic and can dehydrate you. As urine is how uric acid is expelled, being dehydrated can really hurt a gout sufferer. - JNighthawk 22:08, 15 July 2006 (UTC)

[edit] Diagnostic Confusion

Yes, jdwolff, it is the most common mistake made in the mis-diagnosis of gout .. in my experience. However, I can not point to any references, only my experience.

[edit] Extra-articular effects

rstWhat about extra-articular effects of the deposition of uric acid crystals ? Soft tissue, kidneys etc
Kpjas 07:43, 8 Oct 2003 (UTC)

Why don't you add that in? --Alex.tan 07:06, 9 Oct 2003 (UTC)

[edit] Overindulgence

Should not drinking alcohol to excess have been removed from the bulleted list? (as a method of avoiding dehydration)

And gout is commonly believed to be caused by overindulgence in rich food and alcohol... could someone debunk this if it's not true. fabiform 02:24, 11 Jan 2004

I was a vegetarian in my 20s when I had my first gout attack, and I hardly ever drink alcohol. -phma 14:50, 27 Jun 2004 (UTC)

There's also a genetic component to this condition. Gout sometimes runs in families. I have it, and so have others on both sides of my family. I'm pretty sure I've got a genetic predisposition towards gout.

JesseG 06:02, Jun 5, 2005 (UTC)

I recently had an attack of gout. My doctor decided to draw blood to do a test for uric acid. He said that the normal level was from about 3 to about 7 mg of the stuff, mine was up over 8.

JesseG 19:48, July 23, 2005 (UTC)

My first gout attack was after eating a lot of rich French goose liver spread Pate de foie gras. My second gout attack was triggered by a bottle of beer a couple years later. It was not necessarily the alcohol contents but the brewer's yeast that caused the on-set. Brewer's yeast is a rich source of purine. Alcohol is not the only cause, but it should be one of the major cause. The overindulgence theory had been around since Roman time. Removing an age old theory because one sufferer didn't drink alcohol is a bad move. Kowloonese 19:01, Jun 7, 2005 (UTC)

Perhaps there can be a cumulative effect. Being 63 years old I lead a fairly steady life, however we celebrated the end of term with a party last Sunday, and I spent the week eating up the left-overs - salmon, souvlaki and keftedes (meat balls)etc. I had a delicious "ladera" - olive oil based vegetable dish rich in tomatoes, onions, courgettes and aubergines - it is about 50% tomato sauce on Wednesday. Then a few glasses of wine and a couple of beers with friends on Thursday and I woke up yesterday morning with an agonising pain in my right big toe and aches in other joints. I tried drowning it in pain killers, but to no effect, so I went to the doctor this morning and he said "Gout". He has prescribed Colchichine as a short term remedy, 1 mg every two hours. I looked it up on the net, The effects are similar to Arsenic poison, ending with death from respiratory problems. I have supplemented it with cherries. If you do not hear from me again you can assume that this is a somewhat unwanted side effect. Otherwise, I will report progress. (please see warning at bottom of post) Sunday 16.15 GMT I have kept a log of the effects of the medication I have taken since starting to take Colchichine yesterday at 11.00 GMT. 13.00 GMT No noticeable effect. Went to bed, drank a lot of water, took 1 mg Colchicine,two ibuprofen tablets (400 mg) and one stilnox sleeping tablet. 15.00 GMT Woke up and took another 1 mg Colchicine. no change. 17.00 GMT Woke up. Noticeable improvement in condition generally, less pain but still acute. Took 1 mg Colchichine. No noticeable side effects. Practised the piano - feasible. Surfing the net I discovered that all the foods I had been eating(see above) were prime suspects in causing gout, but this seems to be true of almost everything with any flavour. 19.00 GMT Phoned my brother - a long time sufferer from gout. Told me he took colchichine. Said pain would go in a couple of days. Told me to stop taking tablets when side effects became noticeable - i.e diarrhea. Took 1 mg Colchichine. Drank plenty of water. Ate spaghetti with kefalotiri (cheese) topping. 21.00 GMT Took 1 mg Colchichine and one Ibuprofen. Definite improvement. No side effects noticed. Being 23.00 hours local time I took another stilnox tablet and went to bed. Drank some more water. 21.00 to 05.00 GMT today. Effects of drinking large quantities of water woke me about every two hours for trips to bathroom. Did not take any Colchichine until 05.00 GMT. 05.00 GMT (07.00 local time) Got up. definite improvement - only mild pain. Took 1 mg Colchichine. Drank 1/4 ltre low fat milk. 07.00 GMT Took 1 mg Colchichine and 1 Neurofen plus. Temporarily discontinued medication for High Blood pressure (Triatec and Tenoretic) as both of these are diuretics. Cannot decide whether possible stroke/heart attack is preferable to re-occurence of gout. 09.00 GMT Took 1 mg Colchichine. Mild attack of diarrhea. 13.00 GMT Took 1 Ibuprofen. Colchichine ended. Definite improvement, though still sore. Went swimming. 15.00 GMT Afternoon sleep. 16.45 GMT END OF CHRONOLOGY. I hope this may be of help if you suddenly get a first time attack of gout. Advice received tells me that Colchichine is now an old fashioned remedy with possible dangerous side effects, both long term and short term. "....stop using colchicine as it is very dangerous and causes chromosonal damage."

Glad to hear that you recovered. For me, a lot of fluid and elimination of high purine food from diet kept me gout free for couple of years now. Note that pure water is not as good a hydrating agent as electrolyte type of drinks. To me, my lowest moment was passing a kidney stone because of gout. When the uric acid is concentrate enough, it not only crystalizes into your toe joints, it deposits stones in your kidney too. If you think the gouty toe is agonising, think again for a passing kidney stone. I could tolerate the gout by sitting still. I had to go to the emergency room and asked the doctor to knock me out for the kidney stone. Anyway, keep watching that diet and beer. "May the gout be without you".  :-) Kowloonese 00:09, July 16, 2005 (UTC)

How to describe the pain? Saying it felt like someone doused the foot in gasoline, lit it on fire, dropped a semi on the foot, and drove rusty nails all at the same time to describe the pain doesn't feel to me to do justice to what the pain feels like.

JesseG 22:22, July 27, 2005 (UTC)

It feels like stabbing a blade of knife into the joint. Leave it there and wiggle it occasionally. That is the joint pain. Then for the swollen skin surface pain, your gasoline description seems appropriate. Kowloonese 23:47, September 1, 2005 (UTC)

I recently had one of those "get everything away from my foot" gout attacks a few months ago. I had to take my sock off and lay with it in a specific position to get to sleep. It was probably the most agonizing pain I've ever felt, whenever I moved it. I'm thinking it's right up there with kidney stones and child birth. - JNighthawk 22:15, 15 July 2006 (UTC)

Colchicine is rarely used, but its main side-effects are gastrointestinal upset. All those scary side-effects are rare. Its other main indication is FMF. JFW | T@lk 09:54, 17 July 2005 (UTC)

I don't think it's that rare; I and at least one friend of mine have both been prescribed colchicine - although in my case it was as an adjunct to probenecid. --moof 06:19, 2 September 2005 (UTC)

I've also been prescribed it. I believe doctors tend to use it in extreme cases that don't seem to respond to indomethacin right away. I had an attack that laid me up for almost 2 months and when I was originally in the hospital they said they'd never seen anyone in as much pain as I was in. I'd take some indomethacin for a couple days and no relief was forthcoming, they put me on colchicine and I took 11 doses of it in a single day and it finally broke the worst of it. --Crossmr 20:30, 13 May 2006 (UTC)

Drs prefer using NSAID such as indomethacin due to high risk of adverse effects from colchicine; up to 80% of patients on colchicine experience GI upsets (reference below). However, as a drug it is extremely effective, esp when administered early on (within 24h of symptom onset). May also prove beneficial for pts in whom NSAIDs are contraindicated (due to gastric reflux/ulcer, congestive heart failure, anticoagulant therapy). YC.

Reference Type: Journal Article Record Number: 105 Author: Wallace, S. L. Singer, J. Z. Year: 1988 Title: Review: systemic toxicity associated with the intravenous administration of colchicine - guidelines for use Journal: Journal of Rheumatology Volume: 15 Issue: 3 Pages: 495-9 —The preceding unsigned comment was added by 129.94.6.30 (talk • contribs) 01:43, 6 July 2006.

[edit] Alcohol

Why is alcohol rich in purines? The claims seem unrealistic. In particular, brewer's yeast may be rich in purines (I don't know for sure), but there's no yeast in beer: with very few exceptions (cloudy beers), it's all filtered out before distribution. Also, the current page did not refer to red wine (or port), a classic substance to blame for gout. I've updated accordingly.

I've suffered from gout for 9 years now, and my doctors have almost universally said "diet may help a little, but don't get your hopes up". One mentioned red wine; none have mentioned beer. --Groogle 04:12, 2 April 2006 (UTC)

It probably depends how you got it. Mine was caused by diet, and my doctor said diet and exercise would help the most.—The preceding unsigned comment was added by JNighthawk (talk • contribs) 22:19, 15 July 2006.

[edit] Tea

It wasn't clear - is only green tea and caffinated tea contraindicated in cases of gout? Or herbal teas as well?

Hmmm. Caffeine is a xanthine derivative and hence a purine. I wonder if it really makes if difference. JFW | T@lk 15:29, 2 Jun 2005 (UTC)

Dehydration will cause the on-set of a gout attack. I guess you have to look at both aspects, 1. caffeine is a purine, 2. Tea and coffee are diuretic and hence increase purine concentration via dehydration. Kowloonese 19:16, Jun 2, 2005 (UTC)

[edit] Famous people

Perhaps it's because it is the only mention of gout in the mainstream media, but the mention of king of the hill seems rather incongrous. I'd say either remove it or add more modern-day references if possible.

[edit] Genetics

I believe my problem with gout is partially due to genetics - there have been people on both sides of my family who've had gout. What I was wondering is how gout would work its way down a family tree. Would a person inhierit the condition from his mother's side, or his father's side? Or could it come from either side?
JesseG 02:43, August 11, 2005 (UTC)

My sister and I both suffer from gout, which suggests that any genetic influence is not on the Y chromosome. Also, my father does not suffer from gout, though he does have another arthritic condition. My guess would be that you could inherit from either side of the family, but that only inheriting from the paternal side is unlikely. --Groogle 04:17, 2 April 2006 (UTC)

[edit] Great article but Needs image

It is requested that a photograph or photographs be included in this article to improve its quality.

This is a really good article. I'd put it up for peer review as the first step to featured status, but I'm pretty sure the response would be: needs a picture.

I had a picture of my feet taken during my second episode of gout outbreak. However, the swelling was not severe enough to be representative. Compared to my first outbreak (sorry, forgot to take picture), the picture is not really worth posting. I'll pass this to someone else and I wish I would never have another outbreak again. Kowloonese 23:43, September 1, 2005 (UTC)

[edit] Celery, cherries, strawberries, blueberries: citations

James A. Duke PHD, in The Green Pharmacy makes several comments:

• Some people recommend cherries but suggest a dose of 8 oz a day canned or fresh, these would be expensive and according to the writer its never been scientifically demonstrated but many people swear by it (so it's probably worth a try). The comment is followed by onbe that some people favor strawberries
• Celery: this is the suggestion for celery: tablets of celery seed or celery stalks. The author tried this so it has anecdotal support; he admits he was a skeptic but now believes.
• while clery has the highest recommendation there are also chiso, licorice, turmeric.

The Encylcopedia or Natural Medicine by Murray and Pizzorno lists cherries (again, at a does of half a pound per day) but states it has been shown to be effective in lowering uric acid levels and preventing attacks of gout. It mentions that Cherries, harthron berries blueberries and other dark red-blue berries are rich sources of flavonoids remarkable in preventing collagen destruction and are good antioxidants and inhibit formation of leukotrienes.

The Holistic Herbal by David Hoffamn recommends a tead of burdock root, celery seed and yarrow (not the celery seed, it seems to be common treatment-my comment RJFJR).This includes a note that diet is paramount; "Coffee and tea should be left alone and any over-indulgence in general is out" (I still find 'left alone' to be ambiguous-RJFJR) and "Alcohol has to be totally avoid".

The above refernce also states: that the body metabolises purines into uric acid (which I'm not sure is stated in the article as why a low purine diet is recommended; if not I'll add it).

Can we make specific citations for any of the other statements in the article? If we get a picture I'd send it to peer-review but I suspect we'll be asked to cleanup the citations. (But looks like an excellent article to me!) RJFJR 14:30, September 11, 2005 (UTC)

[edit] Modern commonality

It seems that gout is relatively rare in the modern day but quite common throughout history. What accounts for this? What modern factors have decreased the prevalence of gout? —Lowellian (reply) 10:04, 22 December 2005 (UTC)

It is my opinion that the prevalence of gout is unchanged over the years. What has changed is the duration of an attack from weeks to hours due to modern medication. I can go from laying on the bathroom floor unable to move at 8:00 a.m. to teeing off for 18 holes at 11:00 a.m. Niloc--Niloc 11:43, 6 May 2006 (UTC)

How?! My gout attacks last days to a week or two. 25% of the time during an attack, I can't walk. What medications, life changes, etc. help?—The preceding unsigned comment was added by JNighthawk (talk • contribs) 22:24, 15 July 2006.

Indometacin is the answer!--Niloc 02:57, 18 July 2006 (UTC)

Just FYI, Indomethacin seems to work well for me as well.--Randomthoughts 12:19, 9 September 2006 (UTC)

[edit] Galen

Not sure if citing the second most influential doctor (and perhaps most influential annatomist) in antiquity as a 'gladiatorial doctor' is something that I'd encounter in a reputable publication. But that might be my snobbery talking. Wilhelm Ritter 17:37, 12 August 2006 (UTC)

[edit] Fructose

Since high levels of fructose in diet is a cause of Hyperuricemia, how come this page didn't mention fructose at all ? —The preceding unsigned comment was added by 38.113.177.205 (talk • contribs) 22:12, August 27, 2006.

Not sure, its possible no one has gotten around to adding it yet. You can do so if you think it should be included.--Crossmr 22:21, 27 August 2006 (UTC)

[edit] Podagra?

I was taught that podagra was specifically gout of the first interphalangeal joint of either foot and does NOT refer to gout in general --Gak 21:28, 30 August 2006 (UTC)

Google doesn't exactly give much guidance on this. Its referred to on many sites in the same breath as gout, or qualified with "especially of the big toe" but not "exclusive" to that joint. You might have more luck looking at an actual medical dictionary to get a clearer definition.--Crossmr 02:10, 31 August 2006 (UTC)

My copy of Merck's agrees with User:Gak's assertion; however, it wouldn't surprise me if in antiquity 'podagra' referred to all types of gout. --moof 06:03, 4 September 2006 (UTC)

[edit] Inconsistency with regard to spinach

In the article, under the Prevention section, spinach is simultaneously recommended and avoided:

1) Avoiding alcohol, high-purine foods, such as meat, fish, dry beans (also lentils and peas), mushrooms, spinach,

2) juicing a combination of carrot and spinach can greatly reduce the pains of gout as well as lower euric acid levels.

I don't know which one is correct, though.

--Randomthoughts 17:34, 31 August 2006 (UTC)

Its quite possible that the juice of spinach helps it, but something in the leafy part makes it worse? Someone can possibly provide clarity on that, if none is forth coming we should probably remove it until its cleared up.--Crossmr 22:49, 31 August 2006 (UTC)

Further research seems to indicate that spinach is a food to be avoided and that the compounds (oxalates) involved are soluble (not totally sure on that last point). I'm going to remove spinach juice from the remedy list. http://www.umm.edu/patiented/articles/what_lifestyle_measures_can_help_prevent_gout_000093_9.htm among many other articles--Randomthoughts 18:11, 6 September 2006 (UTC)

[edit] Added to Prevention

Under prevention, I added information from the 2004 study reported in the New England Journal of Medicine. It was very highly reported throughout the media and details that vegetable purines did not affect incidences of gout while confirming that animal flesh sources of purine did increase the incidence of gout. It also reported that low fat dairy products had some preventative effects.

The source was already cited in the references section.

Anecdotally, I'm currently trying to stave off the beginnings of an attack after a week of pork and steak. I stopped drinking milk in quantity years ago due to allergies and generally have a diet that is high in animal products. I'm slightly overweight but not close to clinically obese.--Randomthoughts 12:14, 9 September 2006 (UTC)

(I'm being utterly insensitive)... If it flares, could you take a picture??? Hope it doesn't though... -- Samir धर्म 12:16, 9 September 2006 (UTC)

Haha. It's not much to see, just a bit of swelling and a bit red - not much compared to the last time when it was much worse (didn't have indomethacin). If I can get a good pic, I'll try to take one.--Randomthoughts 17:17, 11 September 2006 (UTC)

[edit] T-Rex with gout

I've added Sue, the T-Rex, to famous people with gout (I know T-Rexes are not people but Sue is really famous). I used the original Nature citation. However few WP readers have access to 1997 Nature so possibly we should change the citation to this Discovery feature about the paper. What do you think? Friendly Neighbour 12:49, 28 September 2006 (UTC)

[edit] Blood pH and bicarbonate as a remedy

I just wanted to mention sodium bicarbonate and its effects on raising blood pH for gout treatment. I'm pretty skeptical, and really don't think remedies such as this should be in the article until reliably sourced, but I've tried baking soda myself whenever I've found myself in the beginning stages of an attack, and I'll be damned if it doesn't work. It seems like such a hokey remedy, and I'm not too keen on the increased sodium consumption, but I've been using baking soda alone for gout treatment for nearly a year, and haven't refilled my indomethacin or painkiller prescriptons since last fall.

But realizing that my own example doesn't make for good science, and that baking soda is all over huckster, home-remedy websites, I'll just advise that people keep their eyes open for any legitimate gout-related studies involving pH.--Trypsin 15:11, 19 October 2006 (UTC)

[edit] Removed - probable vandalism

'Gout symptoms can be completely eradicated by simply mixing a flat teaspoon of baking soda in a glass of water. This stop the prurines from crystalizing in the joints. I am a twin. He suffers and takes medication. I simply brush my teeth with baking soda and that takes care of the problem.' I'm almost sure this is just plain vandalism. --204.155.226.2 17:20, 26 October 2006 (UTC)

If you look at the topic above about bicarbonate, you'll see that it might actually be legit. Still, it is unsupported and unencyclopedic. I fully support the removal. I just wouldn't strictly call it 'valdalism'. --Mdwyer 19:06, 26 October 2006 (UTC)