Gout

Alternative treatment with fewer side effects

Q . I am a renal transplant patient and have what is called pseudo gout. It affects my wrists and sometimes my toes. I treat it with an increase in prednisone for about 1 week gradually decreasing the dose over 1 week. Is there any other form of treatment? Pain pills and high doses of prednisone have created some side effects.

A. As renal transplants become the increasing norm we learn more and more about the problems which can arise. This is a reflection of the success of the transplant program and it is under serious threat from the adverse publicity over such highly publicised dilemmas as in Alder Hey hospital.

Gout is caused by a build of oxalic acid crystals in the joints. The symptoms of gout can be mimicked by other conditions which do not necessarily involve oxalic acid. These are called pseudo gout. Make no mistake the pain can be just the same. I would be wary of using increased doses of steroid to ease the pain as it tends to mask it rather than protect you from joint damage, not to mention problems with skin thinning and stomach ulcers. A chat with your transplant team or a referral to a friendly rheumatologist could help.

I think I may have gout

Q . I think I have the symptons of gout, can you offer any advice?

A. It would be useful to know what your symptoms are so I could comment on them. This is not as strange as it sounds as gout can have many effects on many parts of the body not just the big toe which everyone knows about.

The deposition of uric acid crystals in the joints can cause exquisite pain, swelling, tenderness and heat in almost any joint but the most common are those of the feet, elbows and wrists. It starts off as a dull ache then becomes red hot and tender. It runs in families and is associated with renal stones. You need to drink plenty of water. There is no real connection with port nor do religious leaders suffer from it any more than anyone else, although alcohol does make it worse. The treatment comes in two stages firstly addressing the acute stages then to keep the levels of circulating uric acid down in the blood.... You need to see your GP sooner rather than later as an early diagnosis prevents damage to the joints.