Q: I used to have severe pain in the joint of my toe. Recently I was diagnosed as gout and my uric acid level is 10.7 and ESR is 22 mm. The doctor prescribed a 10 days dose of Zyloric - 300 mg (Allopurinol). After this the blood test revealed that uric acid level as 5.78 but E.S.R level was still 22. Does the uric acid have to be controlled by tablets and diet only? And if the uric acid levels are normal, then can I resume my normal diet. I am 100% vegetarian and non alcoholic. I do not have any other infections. What could be the cause of ESR not getting reduced?

A:I strongly recommend that you see a RHEUMATOLOGIST (physicians specialising in joint diseases) for correct diagnosis of your case. It needs a specialist to evaluate the problem and then, diagnose gout by demonstrating monosodium urate crystals in the joint. Once the diagnosis is established the treatment consists of several modalities that are given simultaneously including: 1. Life-style modification. 2. Treatment of acute attacks. 3. Strategies for preventing acute attacks. 4. Bringing down uric acid (in case it is required). As you can see, treatment of gout is not one of those simple things that you take a few pills of allopurinol and that is the end of it. By-the-way, ESR of 22 mm in the first hour is supposed to be normal by American College of Rheumatology. I suggest that you should not worry about it at all.