Mr. XY is a 51-year-old truck driver who went to his primary care physician complaining of painful left ankle for three days. His pain was very severe to the point that he was limping while walking. He denied any trauma, injury, fall or any direct impact to the ankle. The ankle was swollen and warm to touch. When asked about any recent changes in medications or diet, he disclosed that he had been eating a lot of beef jerky lately. Also, he had started walking more distance in his neighborhood park and had not been drinking enough fluids. After thorough evaluation, it was concluded that he was suffering from acute gout attack from excessive consumption of beef jerky and dehydration.
Image Source: National Institute of Health
Gout is a painful joint condition caused by precipitation of uric acid crystals in the joints. Uric acid may increase in the body by either increased production or decreased clearance of uric acid. Obesity, high blood pressure, chronic kidney disease and medications that increase uric acid levels in the blood are the common risk factors for gout. Food triggers for gout include excessive alcohol consumption, purine-rich animal protein (beef, lamb, pork, shellfish), high fructose corn syrup among others. Purine rich vegetables usually do not increase the risk of gout. Coffee and vitamin C may help in lowering the uric acid levels.
Mr. XY was prescribed colchicine for treatment of his gout flare up with above mentioned dietary recommendations. He felt significantly better within few days and his ankle symptoms resolved. Since he did not have recurrent attacks of gout he was not put on any preventive gout medication. Other medications that can help a gout flare up include steroids and NSAIDs (ibuprofen, naproxen, indomethacin etc.)
Those who have recurrent gout attacks, preventive medications like Allopurinol and Febuxostat may help to keep the uric acid levels at goal (<6). Other less commonly prescribed medications are Probenecid, Lesinurad & Pegloticase.
Mr. XY now exactly knows how to prevent another gout attack!
Note: Inspired from true patient encounters from clinical practice for educational purpose only. Names, characters, businesses, places, events, locales, and incidents are either the products of the author's imagination or used in a fictitious manner. Any resemblance to actual persons, living or dead, or actual events is purely coincidental.
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