Ask the Doctors September 2017 Issue

Ask The Doctors: September 2017

Dr. Steven Maschke

Arthritis Advisor Editor-in-Chief Steven Maschke, MD, Department of Orthopaedic Surgery, Cleveland Clinic Orthopaedic & Rheumatologic Institute.

Q: I’ve had attacks of gout in my big toe. Now I’m getting joint pain and swelling in my hands. Can you get gout in your hands?

A: Gout is a painful form of arthritis that usually affects joints in the lower body, primarily the big toe, but also the ankle or knee. But gout attacks have been documented in almost every joint, including the fingers, wrists and elbows.

Attacks of gout happen in people with high levels of uric acid in their blood. Uric acid is a byproduct of natural processes in the body. Normally, it passes through the kidneys and leaves the body in urine. Some people have an inefficient system for getting rid of uritc acid and it builds up in the blood. When the level goes above 6.8 milligrams per deciliter (mg/dL), it can leave the bloodstream and settle in joints. From there it can break down and release crystals into the joint space.

These crystals are the cause of the red, hot and swollen joint of a gout attack. Short-term treatment is aimed at reducing the symptoms, often with nonsteroidal anti-inflammatory drugs (NSAIDs) or the drug colchicine. The long-term goal is to prevent subsequent attacks by lowering the level of uric acid in the blood and keeping it consistently below 6 mg/dL. This is done with medication, such as allopurinol (Zyloprim®) or febuxostat (Uloric®)

Once a gout attack is over and you feel better, it’s easy to forget to take uric-acid lowering medication. But you need to continue. Since you’ve had more than one gout attack, we advise seeing your doctor to get your uric acid levels tested and make sure you are on the correct dose of a uric-acid lowering medication. If you take the medication faithfully, future gout attacks can be prevented.

Q: I’ve been told I have diffuse idiopathic skeletal hyperostosis. What is this, and what can be done for it?

A: Diffuse idiopathic skeletal hyperostosis (DISH) is a condition that mostly affects the spine. For unknown reasons, ligaments in the back where they attach to the spine calcify into a bone-like material, a process called ossification. It mostly affects the middle (thoracic) spine, but it can also occur in the lower (lumbar) and upper (cervical) spine. DISH may not cause any symptoms, and many people are not aware they have it. It becomes more common with age. One study estimated that it may be present in as many as 25 percent of men and 15 percent of women over age 50 in the United States.

Since many people have no symptoms DISH often is diagnosed only when imaging studies are done for some other reason. Sometimes it can cause mild to moderate pain and stiffness in the back or neck, reducing flexibility in the spine. In some people with severe and widespread calcification, spine fractures can be a complication. In rare cases, the ossified structure can press on the esophagus, causing difficulty swallowing, or press on the spinal cord, causing neurologic symptoms.

There is no cure for DISH, and no medication will slow down the process. To reduce any pain, your doctor may recommend acetaminophen (Tylenol®) or a nonsteroidal anti-inflammatory drug (NSAID), such as naproxen (Aleve®) or ibuprofen (Motrin®, Advil®). You can also apply heat. If you’re having stiffness, exercise may help. Talk to your doctor or a physical therapist about the most appropriate exercises.

While the cause of DISH is not yet known, it may be linked to obesity and diabetes. If you are overweight, try to lose weight, which will reduce stress on the spine.

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