Q: I am suffering from Gout (Rheumatoid Arthritis). The problem started with acute pain and inflammation in the joint under right big toe. At that time uric acid level was 7.1. After taking Zyloric and less intake of some food protein, the problem was solved. But since then uric acid levels are fluctuating from 4 to 10. The pain has spread from knee to the lower portion of both legs. I am taking one zyloric tablet twice a day. How long can Zyloric be taken without causing any side effects? Is there a better medicine than Zyloric? What foods should be avoided and which ones are reccommended? Can gout lead to some other diseases as well? What precautions should be taken?

A:First, your disease appears to be gout and not rheumatoid arthritis! When uric acid levels in the blood are as high as 7 mg/dL), uric acid can deposit in joints and cause arthritis, which is called gout. Fortunately, in most people with high uric acid, arthritis never develops. Only about 5% go on to develop gout. Once gout has developed, the best way to treat it is by lowering uric acid in the blood to a safe level of about 5 mg/dL or less. This is best done when the acute attack of gout has subsided. Zyloric (allopurinol) is a very good drug for lowering uric acid. However, since the treatment has to be continued life-long, this decision of starting Zyloric must be taken seriously. Generally, we do not recommend the drug unless one gets at least 3 attacks of gout in a year. Regarding diet, vegetarian diet is permissible and withholding any item is not very helpful in controlling uric acid. On the other hand, non-vegetarian diet, particularly, red meat is forbidden! The other disease which uric acid can cause is stones in the kidneys. Treatment is again lowering uric acid.