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Does high uric acid cause gout?

Q: I read somewhere that high uric acid has nothing to do with gout and is only an indication of poor general health. I am a 73 years old man having high uric acid approx 6.0 - 6.5 and take Allopurinol 50 mg daily. I do exercises daily to remain fit and take only vegetarian diet with low fat levels. I have suffered 3 attacks of gout in the last 10 years; my big toe gets swelling with severe pain. Is gout a permanent disease or is it curable? Other than Allopurinol, what are the other medications available for the treatment? Which are the foods containing purines that one has to avoid / eat less?

A:I may have been misunderstood. I meant that hyperuricaemia is a widespread problem of adult males in India mainly because of poor eating habits (high calorie, refined foods with very little raw salads, fruits, and diet lacking in foods with high fibre content), sedentary habits and of course, genetic factors.

The other point is that related to high uric acid and gout. If you follow all the persons with high uric acid in the population for long periods of time (several decades - this has been done for research purposes) very few persons develop gouty arthritis. But, a large number of them develop high blood pressure, high blood lipids (cholesterol and others), diabetes and heart attack, kidney disease etc. Therefore, we doctors do not treat blood uric acid but advise the patients to change their lifestyle to prevent these problems. This is because uric acid does not directly cause these problems but only as a 'Good watchman' - tells us that the person is leading a poor lifestyle that needs a change and, may have a genetic background for having these diseases. Taking medicines to reduce blood uric acid levels (like 'Xyloric-allopurinol) has not been shown to reduce the chances of these diseases. Therefore, we do not routinely advise Allopurinol to such persons but advise them to change their life style and take proper treatment for high BP, diabetes, heart disease, kidney disease.

Of course for those small proportion of patients with family history of actual gouty arthritis - the advice is the same i.e. change in lifestyle (as given above) but additionally they are treated for gouty arthritis.

For the treatment of gouty arthritis it is strongly recommended that you immediately contact a good rheuematologist - physicians specially trained in the evaluation of joint diseases, diagnosing joint diseases and in their treatment. As orthopaedic surgeons are not physicians - they are not trained in the treatment of this complicated metabolic abnormality over a long period of time.

Of course, for the treatment of gout, there have been some extremely important recent advances that only rheumatologists are aware. The point to remember is that 'Zyloric' is not the treatment for acute gouty attack but it is meant to prevent future attacks over long-term. The treatment of acute gouty attack is treated with drugs called NSAIDS/COXIBS or, more recently, with glucocorticoids given for 5 days. But, it is very important to 'cover' the immediate post-treatment phase with small doses of colchicine for up to 6 months to prevent any 'withdrawal-flares'.

In short it is rather complicated and meant to be treated only by specialists namely rheumatologists. Lastly, being a genetic metabolic problem, the treatment is needed lifetime.

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