To Your Good Health: Treat the gout, not the elevated uric acid level

DEAR DR. ROACH: I got a call from my internist that my blood test showed an elevated uric acid and I would need to start allopurinol for gout. I had been having big-toe pain at night. A nurse friend gave me some of her tart cherry extract pills to take until I started medication. Before picking up the medication, I read online about people who had affirmed time and time again that taking tart cherry, in almost any form, relieved their gout pain. I decided to continue it to see how long the relief would last.

That was three years ago, and I have not needed the allopurinol nor had to worry about the side effects that can accompany it. I do not take the tart cherry pills/capsules daily, only when twinges start. Sometimes I just keep tart cherry juice or the canned cherries themselves on hand. Much easier, and cheaper as well. It may not work for everyone, but it certainly was worth a try! I am yet another affirmation of at least trying an alternative. – P.B.

ANSWER: I’m glad it worked for you, and it gives me a chance to talk about the difference between gout and having high uric acid levels.

Gout has been known since ancient times. The word gout comes from the Latin “gutta,” meaning “drop.” It reflects the theory of humors, which was what was thought to cause the disease. Actually, it is caused by the deposition of uric acid crystals into a joint, usually a single joint such as the big toe, where it has the lovely, old-fashioned name “podagra.” Most cases of gout are exquisitely painful, with intense redness and swelling. Many people cannot tolerate even a sheet on top of their foot, and I have seen people sleep with their foot in a shoebox. There are some people who have much more mild symptoms, but I wonder if the big-toe pain at night you are describing really was acute gout.

If it was gout, then treatment would be appropriate. There are several options, including allopurinol, the newer febuxostat (Uloric) and colchicine. However, if that big-toe pain were from a different cause, such as osteoarthritis, then the discussion is about whether to treat people who have asymptomatic high uric acid levels. Experts are divided about this, but many (including myself) do not treat a mildly high uric acid level by itself. Instead, it’s appropriate to look for other drugs the person may be taking that can cause it (especially thiazide-type diuretics like HCTZ), and have the person avoid high uric acid foods like shellfish and beer, and reduce sugar consumption.

Tart cherries — as juice, extract or whole fruit – reduce uric acid levels and risk of gout flares in people with a history. However, any treatment to reduce uric acid levels can have the paradoxical effect of precipitating an attack in the short term.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.