Dr. Keith Roach: The role of steroids in gout control
Dear Dr. Roach: Our 44-year-old son was diagnosed with gout 10 years ago. He was given different medications to help with the terrific pain. Several of the meds were steroids. He seems to have this condition under control, somewhat. However, one year ago, he started to experience a different kind of pain in his hips. After a visit with an orthopedic surgeon, he was diagnosed with avascular necrosis, a lack of blood flow to his hips. Could the avascular necrosis be a result of the medication he took for the gout? The surgeon does not want to do hip replacement due to his young age, and is suggesting our son use ibuprofen to help with the pain in his hips. Is there something that might help our son overcome this situation? He is otherwise a healthy young man.
Dear Anon.: Gout is caused by the deposition of uric acid into joints or other areas of the body, including as kidney stones or in the soft tissue of skin and the ear. However, it’s most common as a severe joint inflammation, especially of the big toe.
Steroids sometimes are used for acute gout, but rarely are they used long term because of their multiple risks, including avascular necrosis, the death of bone tissue caused by poor blood flow. Other causes for AVN include alcohol use, sickle cell disease and Gaucher disease. Unless your son has one of these other causes, it’s very likely that the steroids had a primary role in his development of AVN. This is a shame, since there usually is effective treatment for gout that is much less risky than steroids.
The goal of treatment for AVN is to relieve symptoms while avoiding surgery for as long as is practical. Ibuprofen is likely to help, but only about 20 percent of people get really good results with pain management, combined with activities as tolerated, including the use of crutches if necessary. Although there is some promising data on the use of treatments such as hyperbaric oxygen and alendronate (Fosamax) in AVN, the evidence is not yet strong enough for me to recommend either.
As far as surgical treatment goes, there are many types, ranging from fairly limited surgery to complete hip replacement. Only his orthopedic surgeon can make the determination of which is best for him, and the timing depends on his response to nonoperative therapy.
Dear Dr. Roach: I use 100 percent pure coconut oil to moisturize my skin and hair. Is any reason to worry about it being absorbed into the blood?
Dear Anon: Coconut oil is not absorbed, to any significant degree, through the skin. Many people find it helpful as a skin moisturizer, although it can block pores, causing acne for some.
Email questions to ToYourGoodHealth@med.cornell.edu.