Wednesday is Prince Spaghetti day, at least that’s what Anthony says. But any day is a good day for gout, especially Monday. And even though that may have little to do with anything, I thought that maybe we could spend some time over these next few cool crisp fall weeks discussing various forms of arthritis. This week, we got the gout. Arthritis, as the name may suggest for those who were forced to take Latin in high school, is inflammation of a joint and can be due to various causes – systemic disease, trauma, wear and tear, or in the case of gout, a buildup of uric acid in the joints.

Gout is an old disease, referenced in Egyptian medical texts as well as the Talmud, where the pain is described as “like needles penetrating flesh”. Those who are afflicted with gout, which can be a primary disease of high uric acid or secondary to other systemic diseases such as kidney insufficiency, demonstrate elevated levels of uric acid in the blood – either due to over production or under excretion. Uric acid itself is a breakdown product of purines, one of the components of DNA, found in any living being. Certain foods, such as fish and organ meats contain high levels of purines, which are then converted to uric acid, and concomitant consumption of alcoholic beverages can exacerbate the process (for this reason, gout was considered the rich man’s disease – the province of those who could afford meat and wine or beer). This leads to an acute attack as the uric acid comes out of solution in a joint – often the big toe – and the reaction by the body is exquisitely painful, resulting in the characteristic red hot swollen joint.

Treatment of an acute attack consists of anti-inflammatory medicine, such as indomethacin, an NSAID which works particularly well. As horrible as it sounds, corticosteroid injections are extremely effective at stopping an attack almost instantly. And for long term management, medications can be used to reduce the production of uric acid and suppress the inflammatory response. It is important to control the attacks as many attacks over the long term, besides being painful, can create permanent damage and arthritis in the joints.

So if you are still enjoying the mid-autumn BBQ, or having the old New England crab fry and beer garden, and wake up Monday morning with your toe on fire, don’t panic. Even if you haven’t had it before, if there is a family history, and it’s been a rich man’s weekend, you know where to bring that big, big toe.

See you in the office.

Ernest Isaacson