(Originally posted to Personal at EraBlog on Sat, 11 Oct 2003 18:15:39 GMT)

I have gout. It’s an unpleasant form of arthritis. Once or twice a year, one of my lower joints will swell up overnight. Usually, it’s struck one of my knees, though the last few attacks have all been in my feet. The knee attacks have all been extremely painful initially and I’ve required pre­scrip­tion painkillers to get to sleep at night. Just bending my knee a few degrees is enough to make me break out in a cold sweat. For­tu­nate­ly, after a few days, the pain decreases to the point where it’s annoying but tolerable.

Oddly, the feet attacks have been less painful. I had a few pre­mon­i­to­ry twinges in my right foot on Thursday evening, so I took a colchicine tablet. I woke up early yesterday morning to find my foot hurting. I can bend my big toe upwards, but it hurts to lift off from my right foot, so I’m hobbling around stiff-footed with the help of a cane. I can drive, but I don’t think I could manage it it were my left foot, since the clutch requires more pressure than the ac­cel­er­a­tor or brake pedals.

This is the first time that I’ve had a gout attack in my right foot. I had one in my left foot three weeks ago, the day that we were flying back from our vacation in Ireland. I had only one attack in my left foot before that, just as we were about to leave for a two-week driving vacation over last Thanks­giv­ing. For­tu­nate­ly, the anti-in­flam­ma­to­ries brought it under control quickly. Before that, I’ve had four or five attacks, always in one knee or the other, over the last five years. I’ve never yet had an attack in the classic locus of the big toe.

Gout is caused an excess of uric acid forming crystals in a joint. Uric acid is a by-product of the breakdown of purines. High levels of uric acid are due to one or more of three factors: consuming too much food which is high in purines, the body generates too many purines, or the body is not effective at elim­i­nat­ing purines.

I have never consumed sig­nif­i­cant quantities of the foods that are really high in purines, such as organ meats and shellfish, and my con­sump­tion of alcohol is quite modest. I’m probably twenty-five pounds over my ideal weight, my blood pressure is fine, and I’m in my late thirties, so I don’t really fit the stereotype of a fat sweaty squire, quaffing port by the gallon, a la Hogarth. My doctors have been telling me for over a decade that I have a high con­cen­tra­tion of uric acid in my blood.

Some people have a genetic pre­dis­po­si­tion to gout. My father had an attack a few years ago. My mother’s sister reportedly had an attack once or twice, but she’s a hypochon­dri­ac who’s had everything.

I spent most of September and October 2002 limping around because my left knee was swollen due to gout. I couldn’t par­tic­i­pate in last year’s Northwest AIDS Walk, because I couldn’t walk very far. I had expected to walk in this year’s AIDS Walk, which is tomorrow, but it’s unlikely that I’ll be up for it.

For more background on gout, see the gout factsheet, the Gout FAQ, the Health A-Z En­cy­clo­pe­dia, or Forbes: The Disease of Kings.