An Autobiographical Report of Gout in a Patient Unable to Tolerate Conventional Therapy: The Unbearable Pain of Podagra

Gout is typically characterized by hyperuricemia and monosodium urate deposition in and around the joints. In individuals affected by gout, the condition can progress through the following phases: asymptomatic hyperuricemia, monosodium urate crystal deposition, acute gout, intercritical period, and chronic gout. Two of the following are required to establish the diagnosis of gout: at least two attacks, observation or a history of podagra or the presence of a tophus, and prompt response after starting treatment with colchicine. A 65-year-old man whose acute gout attack presented with a warm, exquisitely tender, erythematous, area of swelling that affected the first metatarsal of his left great toe (podagra) is described. A short oral course of prednisone treatment successfully managed his acute gout attack. His subsequent workup revealed a slightly elevated serum uric acid level and bilateral gout-related bone changes that were demonstrated on the roentgenograms of his feet. Several systemic medications are available for the management of acute and chronic gout and to prevent the recurrence of gout. However, for individuals who cannot tolerate or are unwilling to use these drugs, an approach that incorporates alternative and complementary medicine may be considered. The patient was not able to be treated with the standard systemic medications that are usually used for individuals with gout. He decided to take vitamin C (at a daily dose alternating from 500 mg to 1000 mg) after his acute attack resolved, since vitamin C has been demonstrated to lower serum uric acid levels and reduce the risk of gout. After a follow-up period of nearly one year, he has not had a recurrent acute gout attack. In conclusion, several systemic medications are recommended for the treatment and prevention of gout; however, for those individuals in whom the standard drugs for managing gout are either ineffective or contraindicated, alternative and complementary medicines may be used for the management of gout.