QuestionHello Dr. Manger !
I have mild gout in my right toe {first time}. I also have a bone/heel spur at the back of the same foot, very near the achelles tendon which I have had two steroid injections for. There seems to be a difference of opinion between my primary care doctor and my podiatrist regarding treatment of the gout I have.
My primary says he can treat it with medicine,yet my podiatrist says my uric acid level is not elevated enough to warrant treatment at this time.
Normal level is 3.5-8.8
My current tested level is 7.7
The toe is getting better on its own.Or perhaps the podiatrist does not want to interfere with my heel spur treatments since that is causing me the most problem {both problems are in the same foot}.
In your opinion should the gout be treated with a Uric acid level of 7.7 or is the podiatrist correct when he says that 7.7 is considered a high normal and should not be treated with meds at this time ?
Thank You ! for your consideration and advice.
Have a Nice Day !
AnswerRon,
Gout can be treated a variety of different ways. You can take acute treatment at the time of attacks, or you can try to use preventative treatments EVERYDAY to prevent the attacks from coming on. This assumes that the diagnosis is confirmed. The gold standard for diagnosis is to actually remove some of the fluid from the joint that is affected and look for uric acid crystals. We don't always do this, and if the pain, swelling and redness affect a characteristic joint (as in your case), the diagnosis is presumed.
Here is how I treat my patients with gout:
1. If the gout occurs infrequently, less than 2-3 times a year, I tend to treat those patients at the time of the attack with strong anti-inflammatory medications like indomethacin or high dose aspirin. You can also use short courses of colchicine, prednisone, and other pain medications. Frankly, any anti-inflammatory will help.
2. If the gout occurs more frequently, it is worth starting a prophylactic medication like colchicine or allopurinol. This tends to prevent attacks, but must be taken everyday, even if you feel fine.
3. If your uric acid level is above 10, you have deposits of uric acid (called a tophus) in the skin or tendons, and you have a gout attack, it's worth starting allopurinol. Also if you have medical problems (like heart failure or kidney problems) that might put you at risk for using anti-inflammatory medications it's worth starting allopurinol for prevention.
Frankly, since this is your first episode and your uric acid level is normal (though high normal), I'd be inclined to not treat you with the allopurinol (prevention routine) and rather see how you do. I would suggest using anti-nflammatories, however, and this may help the heel spurs as well. For your first episode, I would not commit you to lifelong preventative medication unless your uric acid level was higher.
As an aside, exercise, weight loss, and cutting back on alcohol consumption helps to minimize the chance of an attack.
Hope that helps.
