Passage A
The Taming of Demon Gout
Gout is the aristocrat of diseases. Ancient philosophers and physicians attributed to high living, and it has often afflicted men of exceptional talent. Michelangelo suffered from gout, as did Galileo, Martin Luther, Samuel Johnson, Darwin, Sitting Bull, Theodore Roosevelt and, more recently, Cyrus Vance. Gout was called opprobrium medicorum—the physicians’ shame—because so little could be done to treat it. Victims faced excruciating pain, severe crippling and often death from kidney failure. But modem medicine has turned the demon gout into amicus medicorum—the physicians’ friend.
The typical gout patient is a middle-aged man. Hobbling into the doctor’ s office, he complains of a severe throbbing pain in a joint. The disease usually strikes the foot, but it can also afflict the knee, ankle, elbow and hand. The spot is so sore, he says, that a bed sheet resting lightly on it, or even the wisp of a breeze, produces almost unbearable agony.
One look at the red and swollen toe, hot and full of fluid, tells the physician that he is probably dealing with gout. To confirm the preliminary diagnosis, the doctor draws a sample of fluid from the inflamed spot. Using a microscope, he searches for thin crystals of uric acid, a natural by-product of metabolism that rises to abnormal levels in gout sufferers.
Rheumatologists have learned just how the uric-acid crystals create the painful symptoms of gout. A tiny urate crystal, explains New York University’ s Dr. Gerald Weissman, lodges in a white blood cell near the joint. Eventually, the cell ruptures and dies, releasing toxic enzymes that cause inflammation and searing pain.
Relief: The first stage of treatment is to relieve the acute symptoms. Doctors used to prescribe colchicine, an extract of the autumn crocus whose medicinal value was first discovered by the ancient Greeks. But colchicine has unpleasant side effects, including diarrhea and vomiting. So today, most physicians favor indomethacin, a potent pain killer that also reduces swelling and inflammation. Relief from the pain begins almost immediately.
The second phase of treatment is prevention. Gout patients are usually put on a lifelong course of daily medication. Small doses of colchicine are given for up to a year, followed by one of two newer drugs: probenicid, which increases the excretion of uric acid from the body, or allopurinol, which inhibits production of uric acid. With these medications, many patients never experience a second attack.
The latest research has punctured some of the popular myths about gout.
Examples:
—Overeating. For centuries, gout was blamed on rich food, and patients were kept on a strict diet. Gluttony cannot cause the disease, but eating certain foods can bring on an attack. Uric acid is produced by the breakdown of substances called purines, which are concentrated in organ meats, sardines, anchovies, scallops and other delicacies. Happily, with proper drugs, the gout victim need not curb his appetite. Advises Dr. Gerald Rodnan of the University of Pittsburgh: “Be merry and take your medicine. ”
—Drinking. Alcohol does block the kidneys’ ability to excrete uric acid, but gout patients on medication may imbibe moderately without fear of an attack.
—Talent. For mysterious reasons, gout seems to strike the eminent and successful in disproportionate numbers. Studies of soldiers and college students have demonstrated some correlation between high intelligence and high uric- acid levels. “The connection is beyond grandmothers’ tales, ” says Weissman, “but a lot of trivial explanations are possible. Maybe bright people eat more meat or don’ t urinate as much. ”
To prevent further attacks of gout, what is the main function of a new drug called allopurinol?