Gout

Schwartzman Rheumatology

Sergio Schwartzman, MD

Rheumatologist located in Upper East Side, New York, NY

Gout can cause excruciating attacks of pain, most commonly in the joints affecting the feet. At his practice located in the Upper East Side of Manhattan, world-leading rheumatologist Sergio Schwartzman, MD, has exceptional experience and knowledge in treating patients who have gout and other inflammatory conditions such as pseudogout. Dr. Schwartzman is also a clinical associate professor of medicine at Weill Cornell Medical College of Cornell University, the New York-Presbyterian Hospital, and the Hospital for Special Surgery in New York City. Call the New York City office today to schedule a consultation.

Gout Q & A

What is gout?

Gout is a form of arthritis that can cause attacks of severe pain. It typically affects the feet, especially the big toe. Initial symptoms include swelling and pain in a single joint, with reddened skin that feels warm or even hot to the touch.

Gout and pseudogout (calcium pyrophosphate dihydrate disease, or CPPD) are well-understood joint diseases in which different crystals — uric acid for gout and Calcium Pyrophosphate Dihydrate for pseudogout — cause episodic inflammation in joints.  

In addition to having different causes, there are different associations with diet, medications, and other medical conditions. Although some therapies treat both diseases, there are certain medications that are unique for the management of each condition.

What causes gout?

Certain foods, drinks, and medications are known to cause an increase in uric acid levels that can trigger an attack of gout, including:

  • Shellfish
  • Gravy
  • Red meat
  • Soups
  • Liver
  • Alcohol 
  • High in sugar drinks 
  • High fructose foods
  • Low-dose aspirin
  • Certain diuretics
  • Immunosuppressants

The uric acid crystals that form and cause gout can also collect in the urinary tract and lead to the creation of kidney stones.

How is gout treated?

Gout attacks can be mitigated by making some lifestyle changes, such as reducing alcohol consumption and cutting out foods that cause uric acid elevation in the blood. Cherries and cherry juice are said to help reduce the frequency and severity of gout symptoms.

An active attack of gout can benefit from treatment with a medication called colchicine, which also helps prevent gout attacks. However, colchicine can cause side effects, and some patients can only take low doses because of existing illnesses or the possibility of interactions with other medications.

Many people tolerate NSAIDs (nonsteroidal anti‐inflammatory drugs) better, so a short-term high dose may prove effective in treating patients with acute attacks. Short term corticosteroids are also utilized in certain circumstances as are injections of cortisone.

Biologic agents, such as a drug anakinra, can provide fast relief from the symptoms of gout. 

There are medications that consistently lower uric acid levels. While these drugs do not resolve the symptoms of an acute gout attack, they do help prevent future attacks. Allopurinol and febuxostat both block production of uric acid, and pegloticase, a biologic agent, breaks it down. Probenecid and lesinurad work by aiding removal of uric acid via a renal (kidney) mechanism.

If you need help with the symptoms of gout, call Sergio Schwartzman, MD, today.