I have gout in my left foot around my big toe. It is severe and painful at times, and my doctor has prescribed Colchicine. I would like your opinion on treatment and diet for this condition.
Gout is a form of arthritis that is caused by the abnormal collection of molecules called urates in the affected joints. Urates — the salts of uric acid and a normal constituent of a person’s blood — are usually elevated when gout is present.
No one knows why the closest joint on the big toe is so commonly the first joint to be affected by an attack of gout. It may be that the temperature of the toe joints is lower than the temperature of large joints like the knee or wrist, and that this increases the deposits of urates in the joint. However, any joint can be affected by the disease, and if it is allowed to progress without treatment, other joints will also become involved. The pain of an attack of gout is typically very severe, and the joint will be red and swollen. In someone with long-term gout, the urate crystals are deposited in the bones around the joint, causing deformities and chronic arthritis, and the acute attacks come more frequently.
Urates can also be deposited in other tissues; they can often be seen or felt as hard nodules along the edge of the ear. They may be deposited in the kidneys and lead to kidney failure if the disease is not treated. Attacks of gout were traditionally associated with eating rich food and drinking red wine. Some foods, particularly meats, contain large quantities of the precursors of uric acid. Alcohol can also raise the level of uric acid in the blood and should be avoided until the disease is under control.
Colchicine is so good at relieving a gout attack, that a failure to respond to it promptly should raise a question about the diagnosis of gout. Non-steroidal anti-inflammatory drugs (NSAIDS) can also be used, especially if colchicine cannot be tolerated. Indomethacin (Indocin) is the traditional one. After the acute attack is relieved, treatment of the high uric-acid level in the body should be undertaken. Allopurinol (Zyloprim), which blocks the formation of uric acid, is usually used. Side effects to this are unusual. Colchicine must be continued for several months with the allopurinol to prevent further attacks. The goal of treatment is to remove all the excess uric acid from the body, and treatment is usually continued permanently. This will prevent further attacks and the development of gouty kidney disease or kidney stones. Treatments are also available to increase the excretion of uric acid.