EDITOR'S NOTE: This weekly column by reporter Bill Kettler answers readers' questions about topics of general medical interest with information provided by doctors from PrimeCare, Jackson County's independent practice association.

I understand that gout afflicts many more people than most of us realize. If gout goes untreated, can it lead to heart attack or stroke?

-- René H., Central Point

Many people have heard of this extremely common disorder, but few people learn much about it until it strikes them or someone in their family, says Dr. Larry Levin, a Medford rheumatologist.

Levin says gout is actually a form of arthritis, which causes pain when crystals of uric acid accumulate in or around joints. Many people first experience gout as a painfully swollen joint at the base of the big toe. The pain peaks within one to three days and then recedes. Some people have repeated attacks in close succession. For others, future attacks are few and far between.

Some people develop nodules or masses of uric acid on their elbows, hands, feet or other areas that can be painful and prone to attacks of inflammation.

"Gout is more common the older and older you get," Levin says. Among people between the ages of 45 and 64, about 2.2 percent suffer gout symptoms. The figure rises to 3.1 percent for people between the ages of 65 and 74.

Ninety percent of people with gout have it because the kidneys fail to excrete uric acid that the body produces daily as a byproduct of the destruction of old cells and recirculation of the building blocks of DNA. In the other 10 percent, the problem is an underlying gene defect.

"Normally we excrete that and we're fine," Levin says, "but if a person cannot excrete the daily load of uric acid they develop high blood levels of this substance (a condition called hyperuricemia). Over many years this leads to deposits of uric acid."

When uric acid levels in the body rise too high, tiny crystals begins to accumulate in and around the joints. These eventually cause gout attacks. "Early on the crystals are microscopic," he says. "It takes years of high uric acid levels before they get that first gout attack."

If gout is left untreated for years, attacks may become more frequent and severe as additional quantities of uric acid collect in the body. Eventually this can lead to a condition (tophaceous gout) in which quantities of uric acid collect in the body to form chalky nodules called tophi. If gout progresses to this level, there can be severe and permanent joint damage.

Treating gout has two phases: reducing the inflammation that causes pain during a gout attack; and preventing future attacks. Physicians prescribe steroids or non-steroidal anti-inflammatories to reduce the swelling during an attack. Prescription drugs such as allopurinal or Benemid can be taken to reduce the body's uric acid levels.

It's important that patients don't confuse these two aspects of treatment. Taking an anti-inflammatory drug, for instance, does not lower your uric acid level and does not prevent gout. Likewise, increasing allopurinol during a gout attack will not help relieve the pain.

"It is an eminently curable disease if you stick with the treatment program and normalize your uric acid level," he says.

Certain habits tend to aggravate gout, especially drinking alcohol, because the kidneys stop excreting uric acid when they have to process alcohol. Beer is the worst kind of alcohol, with hard liquor a close second. Wine is third, but not so far behind that it doesn't cause problems, too.

Levin says taking aspirin in moderate quantities also aggravates gout, but the one-a-day baby aspirin that many people take to prevent heart attacks is probably not enough to aggravate gout.

As for any link between gout and heart attack or stroke, Levin says gout is a "mild independent risk factor for atherosclerotic disease.

"It's not a major risk factor (like untreated diabetes or high blood pressure), but statistically it's a small risk factor," he says.

Call Bill Kettler with your medical questions at 776-4492, or e-mail them to: bkettler@mailtribune.com or send them to: Mail Tribune, Ask Your Doctors, P.O. Box 1108, Medford OR 97501.