Q. For gout, what dosage of sodium bicarbonate should be used, how often and how long to lower uric acid? What other recommendations would you make?

A. Thank you for your question on gout. It is a common disease with potential for causing severe joint and kidney problems, so treatment and prevention are indeed important! In the general population, 1-5% of men will be affected by gout. It is much less common in women.

Gout is caused when uric acid crystals are deposited in the joints. The uric acid is a normal substance circulating in the bloodstream, a by-product of metabolizing certain foods. Uric acid levels can rise when too much is produced due to faulty metabolism, or when not enough is excreted by the kidney. The kidney is the culprit in the majority of cases, even when it is functioning normally is all other regards.

Gout causes an acute, very painful arthritis attack, most commonly affecting the joint of the big toe. The diagnosis is confirmed when fluid taken from the joint contains uric acid crystals, however the uric acid levels in the bloodstream may be high or normal. A variety of medicines are available to treat the acute attack, and further measures are needed to prevent future attacks. High levels of uric acid can lead to recurrent attacks, joint damage (gouty arthritis), and kidney stones.

The majority of cases are thought to be caused by inherited problems of metabolism. Certain drugs can increase uric acid levels(most common would be diuretics) and high intake of purines (especially beer, red meat) in the diet can contribute as well.

Prevention usually involves medication such as probenecid to promote the kidney's excretion of uric acid, or allopurinol which decreases the body's production of uric acid. Both of these are done under medical supervision. Bicarbonate intake is not thought to be effective in this regard.

For further information, please see the following article: Pal B, Foxall M, Dysart T, Carey F, Whittaker M. How is gout managed in primary care? A review of current practice and proposed guidelines. Clin Rheumatol. 2000;19(1):21-5. These web sites may also prove useful: http://www.rheumatology.org.nz/nz08003.htm and http://arthritis.about.com/health/arthritis/msub12.htm.

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