Dear Dr. Roach: Since January, I have had gout in my right big toe five times. I was given methylprednisolone (four-mg dose packs) five times. The medicine works only to the point of getting rid of the worst of it, but it comes right back 鈥� sometimes one or two days after taking the last pill. I adhere to the diet provided, take allopurinol daily to help prevent it, do not drink alcohol, take tramadol for pain and just started meloxicam, which masks the pain but has done nothing for the swelling and soreness.
I am 78 and in otherwise good health, but I鈥檓 frustrated with the constant return of the gout.
M.T.
Gout is caused by the deposition of a crystal 鈥� uric acid 鈥� in the body, especially in joints such as the big toe. Gout can also cause kidney stones and tophi, which are solid collections of uric acid (actually, monosodium urate) in the soft tissues. Only humans and Dalmatian dogs get gout.
The treatment for chronic gout is different from the treatment for acute gout. Allopurinol, which lowers uric acid in the blood, actually can cause an acute attack when it is first started.
Anti-inflammatories like meloxicam are a good treatment for acute gout. So is methylprednisolone, a steroid like prednisone. However, these are not ideal for long-term use due to toxicity.
I think a visit with a specialist is a good idea. A rheumatologist is your best bet for an expert in gout. You may require treatment with other medications, at least for a while.
I have had much success with colchicine, given for a few months at the onset of allopurinol treatment. There are several new medications for gout.
