Gout and Wine

[08meltdown]

Currently stricken by Gout.
Red swollen toe, excruciating pain. Moderate wine and red meat consumption (2 glass/day, lunch & dinner). Fairly active and no weight problem.

Appreciate advice/feedback on relieving gout pain and preventing recurrence.
Google search results in alcohol and red meat reduction for prevention.

[KMP]

Even though I’ve worked with rheumatologists for the last 30 years Gout is outside my area but here is a basic outline stolen from the American College of Rheumatology:-

Gout occurs when excess uric acid (a normal waste product) accumulates in the body, and crystals deposit in the joints. This may happen because either uric acid production increases or, more often, the kidneys are unable to remove uric acid from the body adequately. Certain foods, such as shellfish and alcohol, may increase uric acid levels and lead to gout attacks.

Some medications also can increase uric acid levels. Examples of such medications include moderate-dose aspirin (81 mg used for prevention of heart attack and stroke has minimal effect and can generally be continued), diuretics such as hydrochlorothiazide (Esidrix, Hydro-D), and immunosuppressants used in organ transplantation such as cyclosporine (Neoral, Sandimmune) and tacrolimus (Prograf). With time, increased uric acid levels in the blood may lead to deposits of monosodium urate crystals in and around the joints. These crystals can attract white blood cells, leading to severe gout attacks. Uric acid also can deposit in the urinary tract, causing kidney stones.

For more see here

The best advice is to get yourself to a Rheumatologist for a proper diagnosis. It may not be the wine and food that is the problem but you will probably been told to cut back and/or modify the foods you eat.

EDIT: There is also this study of 47,000+ men over a 12 year period that found the following

Alcohol intake is strongly associated with an increased risk of gout. This risk varies substantially according to type of alcoholic beverage: beer confers a larger risk than spirits, whereas moderate wine drinking does not increase the risk.

And then there is the University of Rochester Medical Center’s Purine Restricted Diet!

Mike

[TORB]

To quote my mate The Pie King, "God gave us drugs so that we can enjoy the lifestyle to which we have become accustomed, so it behoves us to use these drugs."

Progout! Never had an attack since I went on the stuff.

[08meltdown]

To quote my mate The Pie King, "God gave us drugs so that we can enjoy the lifestyle to which we have become accustomed, so it behoves us to use these drugs."

Progout! Never had an attack since I went on the stuff.

Does it mean you used to have gout before going on the Red Stuff?
Maybe I should drink more

[Lee]

Any decent GP will get you sorted out, by the time you get into the rheumatologists office, you will be better!

[TORB]

Does it mean you used to have gout before going on the Red Stuff?
Maybe I should drink more

I have never had gout, but have always had higher than normal uric acid levels. My GP figured that it was only a matter of time before I got it, hence an ounce of prevention.

My excuse is that I eat too many tomatoes and to much tomato juice.

[Gary W]

, but have always had higher than normal uric acid levels.

It's probably because you're always taking the piss
GW

[KMP]

Any decent GP will get you sorted out, by the time you get into the rheumatologists office, you will be better!

Would that that were actually true. The equivalent of considering your local supermarket a fine wine specialist!

Mike

[Lee]

Oh yes - in the US you would see a cardiologist to prescribe an anti-hypertensive, or a respiratory physician to treat your bronchitis.

[Sharkey]

To quote my mate The Pie King, "God gave us drugs so that we can enjoy the lifestyle to which we have become accustomed, so it behoves us to use these drugs."

Progout! Never had an attack since I went on the stuff.

Yeah - The drugs for this have been used for nearly 200 years. It is called colchicine and the one I use is branded Lengout.

[08meltdown]

Yeah - The drugs for this have been used for nearly 200 years. It is called colchicine and the one I use is branded Lengout.

So you need to take Lengout daily to prevent gout from recurring?

My uric acid readings for the past decade have exceeded the reference. However my latest 2 years reading are well within the ref, and now Mr Gout decided to pay me a visit
As the saying goes "Your blood tests are normal but the patient is dead"

Done some research on the web (where else!), seems wine consumption do NOT cause any increase in uric acid but beer and spirit do. That's a relief for me. I can continue with wine.
Drinking 4 cups of coffee or more decreases plasma uric acid.

My GP prescribes Indocid (NSAID) and hopefully this will overcome the swelling and pain.

[Sharkey]

Yeah - The drugs for this have been used for nearly 200 years. It is called colchicine and the one I use is branded Lengout.

So you need to take Lengout daily to prevent gout from recurring?

My uric acid readings for the past decade have exceeded the reference. However my latest 2 years reading are well within the ref, and now Mr Gout decided to pay me a visit
As the saying goes "Your blood tests are normal but the patient is dead"

Done some research on the web (where else!), seems wine consumption do NOT cause any increase in uric acid but beer and spirit do. That's a relief for me. I can continue with wine.
Drinking 4 cups of coffee or more decreases plasma uric acid.

My GP prescribes Indocid (NSAID) and hopefully this will overcome the swelling and pain.

It's a bit more complicated for me.

I have a history of high Uric acid plus a history of gout in my family. I have had several attacks in the past, usually in the toes, and started treating with Lengout when they occurred. I can usually feel it coming on and treat it before it gets too bad.

Now, I have a serious allergy to non-steroidal anti inflamatories. In June last year I developed a bad case of viral pericarditis (inflamation of the sack around the heart) and the normal treatment is NSAIDs. The alternative treatment is a low dose of Prednisone and daily Colchesine. So far - if I go off the Colchesine the pericarditus comes back.

So I have been taking a couple of Lengout a day for most of the last 9 months and have not had any indication of gout in that time.

[Lee]

You can use colchicine for prevention of gout, although this use is unusual now - progout is a different drug (drug name allopurinol) which decreases your blood uric acid level by altering the way purines in food are metabolised.

Allopurinol is by far the most common gout preventer used now - colchicine is still used as an acute gout treatment, and when starting allopurinol treatment (as gout often flares in the beginning of treatment).

Colchicine is extremely toxic (ie easily lethal) in overdose, so attention to dosage instructions is needed.

[griff]

Colchicine is extremely toxic (ie easily lethal) in overdose, so attention to dosage instructions is needed.

Not just in overdosage. Some very bad cases seen. Evil stuff.

cheers

Carl

[Sharkey]

Colchicine is extremely toxic (ie easily lethal) in overdose, so attention to dosage instructions is needed.

Not just in overdosage. Some very bad cases seen. Evil stuff.

cheers

Carl

Yes - even slightly over and you can get a very bad case of the runs. My doctor actually wanted me to take it 3 times a day but I had the above side-effect. Cut back to 2 a day and no issues.

[griff]

Colchicine is extremely toxic (ie easily lethal) in overdose, so attention to dosage instructions is needed.

Not just in overdosage. Some very bad cases seen. Evil stuff.

cheers

Carl

Yes - even slightly over and you can get a very bad case of the runs. My doctor actually wanted me to take it 3 times a day but I had the above side-effect. Cut back to 2 a day and no issues.

I was thinking in particular of an elderly woman with poor renal function taking it three times a day and going into multi-organ failure after a few weeks

cheers

Carl

[Lee]

Exactly - which is why your GP should assess your kidneys before suggesting you take it for more than a few days at a time. If it didn't work so damn well it would have faded into history long ago!

[griff]

Exactly - which is why your GP should assess your kidneys before suggesting you take it for more than a few days at a time. If it didn't work so damn well it would have faded into history long ago!

As the saying goes: Desperate maladies require desperate remedies.

Glad I don't have gout.

cheers

Carl

[Scanlon]

dehydration makes it worse - hence alcohol being a diuretic (makes you wee, not give you diarrhoea ) dries you out and encourages the uric acid to comeout of the liquid and crystallise.

if you don't have full gout, you can prevent this by being fully hydrated (ie sticking to the drink followed by water chaser rule).

If you are at a high level though, you need medication.

[KMP]

Oh yes - in the US you would see a cardiologist to prescribe an anti-hypertensive, or a respiratory physician to treat your bronchitis.

Uhm, yes. That is actually quite true - for me anyway. I pay a significant amount of money for health care which includes bypassing what is the equivalent of GPs - called primary care physicians - over here. Having experienced health care in Oz and in the US as well as worked with these folks in my work life for the past 30 years I think I have a fairly good idea of the capabilities of GP/primary care physicians versus medical specialists.

In fact you only have to look at what TORB has written to get a clear idea. He wrote “I have never had gout, but have always had higher than normal uric acid levels. My GP figured that it was only a matter of time before I got it, hence an ounce of prevention.” Normal blood values of uric acid are between 3.0 and 7.0 mg/dL. But a high uric acid level is not the be all and end all of the diagnosis of gout. You can have normal uric acid levels and still get gout, and even with a high uric acid level you can be gout free. Thus there is a good argument that treatment of asymptomatic hyperuricemia is not necessary. To quote one review article

“In the Normative Aging Study, the annual incidence of gout was only 0.1% in people with serum uric acid levels lower than 7.0 mg/dL, rising to 0.5% in people with uric acid levels from 7.0 to 8.9 mg/dL, and to 4.9% with uric acid levels higher than 9.0 mg/dL. Dincer HE, et al, Cleve Clin J Med. 2002 69:594”

So even with significantly high uric acid the chance of developing gout is about 1 in 20. More importantly elevated uric acid can be associated with other medical conditions. Hopefully TORB’s GP is aware of that and made appropriate investigations. Plus a side affect (admittedly uncommon) of Progout include changes in taste sensation!

Even if you have an inflamed joint its still not conclusive that you have gout. The diagnosis is made by taking fluid from the affected joint and finding urate crystals in that fluid (synovial fluid) using polarised light microscopy. This test is necessary because there are other crystals, esp. calcium pyrophosphate crystals, that can deposit in joints. So unless your GP has taken joint fluid and had it examined for urate crystals I'd be looking for a second opinion. And I know which type of doc I would be looking for.

Mike

[Roscoe]

Let us not forget that the US spends nearly twice as much in terms of % of GDP on health as we do (which means that they spend more than twice the amount per capita in real terms) and in terms of life expectancy, perinatal mortality (and most other outcome measures) they do not do as well.
The US health system is a great example to all other countries on how not to run a health system.
It is arguable whether good GPs are an important part of the difference between our (better) system and the US system, but I certainly think they are. There are too many untrained bureaucrats in the US system, spending too much time trying to "save" health dollars without actually providing any services. At the same time their mere existence consumes too many resources. GPs are highly trained and generally very productive. I think they are very effective (in general) in providing both high quality care and efficient use of resources.
BTW, I am a specialist, not a GP.
Sorry for thread drift.

[KMP]

There is no doubt that the way healthcare is run in the US, with some 40-50 million uninsured, is not ideal, but then I'm not sure there is an ideal system. After years seeing how my relatives get (or don't get) healthcare in a place like Dubbo, NSW my wife and I have serious concerns about retiring to Australia if we can't be close to a major population center.

Its only really been in the last few years that I have personally experienced any problem with the US system and that has been in terms of what insurers will pay for medication. I was on a wonderful drug for GERD but its cost was far greater than other similar but not as effective drugs and so I now have to take a cheaper drug. Still that has meant that I am now more amenable to lifestyle changes than I was.

Mike

[Bick]

... but then I'm not sure there is an ideal system.

If you can stomach the taxation required, the Scandinavian health systems are pretty flash I believe.

[Roscoe]

Equity of access is a problem in Australia and is probably growing. It is less of a problem than in the the US, as you pointed out Mike. I believe the Scandinavian systems are very good. There is not a perfect system and I'm not sure there ever will be. Health has the potential to consume many more resources than we are prepared to throw at it.
As for NZ, I think you guys spend quite a bit less than us, but your health outcomes are not at all shabby, even if I suspect your health system is considered a bit on the nose at home. It's full of great people, but probably underfunded.
p.s. I think Dubbo is better served than a lot of other regional centres.

[Lee]

One instance of unusual management by a GP is hardly enough to tarnish us all (Yes, I am a GP) - it is not normal practice to treat uric acid levels in isolation. In fact, measuring uric acid in the absence of renal disease, some myeloproliferative conditions and suspected gout is rarely useful, I for one don't routinely.
And some of us do aspirate joints to check for urate crystals, this is usually as a confirmatory step once treatment is already instituted though. I can't recall a single patient being managed here by a rheumatologist for gout. None in the practice I work in anyway.....

Oh yes - in the US you would see a cardiologist to prescribe an anti-hypertensive, or a respiratory physician to treat your bronchitis.

He wrote “I have never had gout, but have always had higher than normal uric acid levels. My GP figured that it was only a matter of time before I got it, hence an ounce of prevention.” Normal blood values of uric acid are between 3.0 and 7.0 mg/dL. But a high uric acid level is not the be all and end all of the diagnosis of gout. You can have normal uric acid levels and still get gout, and even with a high uric acid level you can be gout free. Thus there is a good argument that treatment of asymptomatic hyperuricemia is not necessary. To quote one review article

snip

Even if you have an inflamed joint its still not conclusive that you have gout. The diagnosis is made by taking fluid from the affected joint and finding urate crystals in that fluid (synovial fluid) using polarised light microscopy. This test is necessary because there are other crystals, esp. calcium pyrophosphate crystals, that can deposit in joints. So unless your GP has taken joint fluid and had it examined for urate crystals I'd be looking for a second opinion. And I know which type of doc I would be looking for.

Mike

[Davo]

Any decent GP will get you sorted out, by the time you get into the rheumatologists office, you will be better!

Would that that were actually true. The equivalent of considering your local supermarket a fine wine specialist!

Mike

I can't recall ever sending someone with gout to see a Rheumatologist.

[Davo]

Oh yes - in the US you would see a cardiologist to prescribe an anti-hypertensive, or a respiratory physician to treat your bronchitis.

Uhm, yes. That is actually quite true - for me anyway. I pay a significant amount of money for health care which includes bypassing what is the equivalent of GPs - called primary care physicians - over here. Having experienced health care in Oz and in the US as well as worked with these folks in my work life for the past 30 years I think I have a fairly good idea of the capabilities of GP/primary care physicians versus medical specialists.

In fact you only have to look at what TORB has written to get a clear idea. He wrote “I have never had gout, but have always had higher than normal uric acid levels. My GP figured that it was only a matter of time before I got it, hence an ounce of prevention.” Normal blood values of uric acid are between 3.0 and 7.0 mg/dL. But a high uric acid level is not the be all and end all of the diagnosis of gout. You can have normal uric acid levels and still get gout, and even with a high uric acid level you can be gout free. Thus there is a good argument that treatment of asymptomatic hyperuricemia is not necessary. To quote one review article

“In the Normative Aging Study, the annual incidence of gout was only 0.1% in people with serum uric acid levels lower than 7.0 mg/dL, rising to 0.5% in people with uric acid levels from 7.0 to 8.9 mg/dL, and to 4.9% with uric acid levels higher than 9.0 mg/dL. Dincer HE, et al, Cleve Clin J Med. 2002 69:594”

So even with significantly high uric acid the chance of developing gout is about 1 in 20. More importantly elevated uric acid can be associated with other medical conditions. Hopefully TORB’s GP is aware of that and made appropriate investigations. Plus a side affect (admittedly uncommon) of Progout include changes in taste sensation!

Even if you have an inflamed joint its still not conclusive that you have gout. The diagnosis is made by taking fluid from the affected joint and finding urate crystals in that fluid (synovial fluid) using polarised light microscopy. This test is necessary because there are other crystals, esp. calcium pyrophosphate crystals, that can deposit in joints. So unless your GP has taken joint fluid and had it examined for urate crystals I'd be looking for a second opinion. And I know which type of doc I would be looking for.

Mike

A certain case of a little knowledge...

[TORB]

A certain case of a little knowledge...

I wasn't going to say anything until you made your comment. As you know, my medical situation is not exactly straightforward, so Mikes conclusions do not in any way take into account all the facts of why I am on Progout.

[KMP]

Oh yes - in the US you would see a cardiologist to prescribe an anti-hypertensive, or a respiratory physician to treat your bronchitis.

Uhm, yes. That is actually quite true - for me anyway. I pay a significant amount of money for health care which includes bypassing what is the equivalent of GPs - called primary care physicians - over here. Having experienced health care in Oz and in the US as well as worked with these folks in my work life for the past 30 years I think I have a fairly good idea of the capabilities of GP/primary care physicians versus medical specialists.

In fact you only have to look at what TORB has written to get a clear idea. He wrote “I have never had gout, but have always had higher than normal uric acid levels. My GP figured that it was only a matter of time before I got it, hence an ounce of prevention.” Normal blood values of uric acid are between 3.0 and 7.0 mg/dL. But a high uric acid level is not the be all and end all of the diagnosis of gout. You can have normal uric acid levels and still get gout, and even with a high uric acid level you can be gout free. Thus there is a good argument that treatment of asymptomatic hyperuricemia is not necessary. To quote one review article

“In the Normative Aging Study, the annual incidence of gout was only 0.1% in people with serum uric acid levels lower than 7.0 mg/dL, rising to 0.5% in people with uric acid levels from 7.0 to 8.9 mg/dL, and to 4.9% with uric acid levels higher than 9.0 mg/dL. Dincer HE, et al, Cleve Clin J Med. 2002 69:594”

So even with significantly high uric acid the chance of developing gout is about 1 in 20. More importantly elevated uric acid can be associated with other medical conditions. Hopefully TORB’s GP is aware of that and made appropriate investigations. Plus a side affect (admittedly uncommon) of Progout include changes in taste sensation!

Even if you have an inflamed joint its still not conclusive that you have gout. The diagnosis is made by taking fluid from the affected joint and finding urate crystals in that fluid (synovial fluid) using polarised light microscopy. This test is necessary because there are other crystals, esp. calcium pyrophosphate crystals, that can deposit in joints. So unless your GP has taken joint fluid and had it examined for urate crystals I'd be looking for a second opinion. And I know which type of doc I would be looking for.

Mike

A certain case of a little knowledge...

Only 30 years of exposure to the literature and a working relationship with those in the forefront of research in rheumatology.

Mike

[KMP]

A certain case of a little knowledge...

I wasn't going to say anything until you made your comment. As you know, my medical situation is not exactly straightforward, so Mikes conclusions do not in any way take into account all the facts of why I am on Progout.

My conclusions were based on what you wrote Ric - (I have never had gout, but have always had higher than normal uric acid levels. My GP figured that it was only a matter of time before I got it, hence an ounce of prevention

My excuse is that I eat too many tomatoes and to much tomato juice.)

I didn't (and don’t) have any other knowledge of your health problems than that.

The point I was trying to make is that the diagnosis of gout is more than simply seeing a swollen joint and getting a serum uric acid level back that is elevated. If there is anyone out there with a medical degree that disagrees with that then I’d like to see the published work that proves it.

Mike

One example of where I am coming from
Clinical diagnostic criteria for gout: comparison with the gold standard of synovial fluid crystal analysis. J Clin Rheumatol. 2009 15:22-4.
Malik A, Schumacher HR, Dinnella JE, Clayburne GM.

BACKGROUND: Several classification or diagnostic criteria sets for gout have been proposed but none validated. OBJECTIVE: This small pilot study considered urate crystal identification as the gold standard for diagnosis and compared the clinical aspects of 3 proposed criteria sets with that standard. METHODS: Eighty-two subjects who had synovial fluid analyses in a VA medical center were studied. ARA (ACR), Rome, and New York clinical criteria sets and individual criteria were recorded in the 30 patients who had urate crystals versus the remainder with no urate crystals. RESULTS: Presence of 2 of 3 Rome clinical criteria had the highest positive predictive value at 76.9%. None of the 3 studied criteria sets were more than 70% sensitive or 88.5% specific. The clinical features of the ARA (ACR) preliminary classification criteria had 70% sensitivity and 78.8% specificity. CONCLUSIONS: The various proposed clinical criteria can provide support for a diagnosis or exclusion of gout, but unless improved criteria can be developed crystal identification should remain the gold standard.