Transcript of interview with Dr. Brian Mandell
I’m Brian Mandell. I’m professor and chairman of academic medicine at the Cleveland Clinic in Cleveland, Ohio. I’m a member of the department of rheumatic and immunologic diseases at the clinic. I edit for the Manual, the sections on rheumatology, immunology and allergy.
Gout is an incredibly common, incredibly painful disorder. It’s increasing in frequency. It’s most common in men, but women certainly get gout as they get older. And its major symptom is the acute, or sudden, onset of amazingly painful red, swollen joint, often the great toe, which is called podagra.
Now, as patients think about gout as a sudden red swollen joint, the real disease is the deposition of uric acid—a normal chemical that all of us have in our bodies. But if the level of that chemical increases above the saturation point, it’s as if you were making yourself an iced tea and you poured sugar into that iced tea and you stirred it up and it goes in perfectly fine, but you add some more in and you stir it up and it settles out in the bottom of that glass. That’s what happens with uric acid when it’s too high in our blood, it settles out in and around joints.
So the great toe, the foot, the ankle, the knee, any joint in the body, in fact, can be affected by the gout. There is a classic description of an acute gout attack where a gout sufferer describes the pain of a bed sheet on their foot as just so intolerable that it couldn’t be able to be standed without great suffering.
We treat the symptoms of gout reasonably, if not extremely well, with anti-inflammatory medicines. The bigger issue is how we get rid of the uric acid deposits in the body. So to get rid of the deposits, which is really treating the gout disease, we can do with several medications now, usually in a pill form, although it does take many years to dissolve those deposits.
A few things that patients with gout can certainly do that will be helpful will be to avoid excesses in beer, including nonalcoholic beer, which will elevate the levels of uric acid more than other compounds that we eat. So I think as dietary changes we generally recommend a healthy common sense diet avoiding excess, avoiding high-fructose corn syrup, beers, and my own advice to people in general is you should avoid drinking cheap wine.