DEAR DR. ROACH: Since January, I have had gout in my right big toe five times. I have been treated by an internist, and was given methylprednisolone (4-mg dose packs) five times. The medicine works only to the point of getting rid of the worst of it, but it comes right back — sometimes one or two days after taking the last pill. I adhere to the diet provided, take allopurinol daily to help prevent it, do not drink any alcoholic beverages, take tramadol for pain and just started meloxicam, which so far masks the pain some but has done nothing for the swelling and soreness. The worst part is that the joint at the top of my big toe is about the size of a quarter and will not heal completely, rubs and continues to be tender even after taking the methylprednisolone.

I cannot exercise much with the foot pain, and the continued return of the gout is causing a bump like a bunion on my toe. I am 78 and in otherwise good health, but I’m frustrated with the constant return of the gout. If I were to go to a specialist, what type of specialist would you recommend? — M.T.

ANSWER: Gout is caused by the deposition of a crystal — uric acid — in the body, especially in joints such as the big toe. Gout also can cause kidney stones and tophi, which are solid collections of uric acid (actually, monosodium urate) in the soft tissues. Only humans and Dalmatian dogs get gout.

The treatment for chronic gout is different from the treatment for acute gout. Allopurinol, which lowers uric acid in the blood, actually can cause an acute attack when it is first started. Anti-inflammatories like the meloxicam you are taking are a good treatment for acute gout. So is methylprednisolone, a steroid like prednisone. However, these are not ideal for long-term use due to toxicity.

Since you are still having symptoms, I think a visit with a specialist is a good idea. A rheumatologist is your best bet for an expert in gout. You may require treatment with other medications, at least for a while. I have had much success with colchicine, given for a few months at the onset of allopurinol treatment. There are several new medications for gout.

The booklet on gout explains this illness in greater detail. Readers can order a copy by writing: Dr. Roach — No. 302, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. ROACH: I have had a condition all my life: very little hair on my face, except for mustache and chin hair. My grandfather, father, son and grandson all had or have full beards. Is this a genetic problem, or something I did or didn’t do? This may seem like a small item in view of all your mail, but an answer would be appreciated. — W.E.F.

ANSWER: Facial hair certainly is genetically controlled to a large extent, but the genetics is complicated. At least some of the genetics is X-linked, meaning that it’s your mother’s father that best predicts what your facial hair will be like. However, there are few conditions that are like the classic single gene we learned about in school, and your situation proves that.

I can reassure you that you didn’t do anything wrong or fail to do something right. Since you have children and grandchildren, I can be pretty sure you are OK.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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