Many of us have seen cartoon depictions of an overweight man in obvious pain with his foot swathed in bandages and propped up on a stool. The artist might even have underscored the excruciating pain of an acute attack of gout by drawing some vicious animal that's gnawing at his foot.

Gout, which is more common in men, affects more than 5 million Americans. The disorder is best known for its attacks of sudden severe pain, redness, and swelling, most often felt first in a great toe.

These acute episodes occur in people with elevated blood levels of uric acid, during times when the deposition of tiny uric acid crystals is going on within a joint, where they cause inflammation. High blood levels of uric acid can also produce chronic manifestations of gout when uric acid is deposited

• in the skin (referred to as tophi), often in the earlobes
• in various joints, causing deformities and limitations of movement
• in the kidneys, resulting in kidney failure
• in the kidneys, where the crystals can form kidney stones

Lowering blood levels of uric acid can help to prevent both acute attacks of gout and its chronic complications.

Overweight or obese individuals may decrease uric-acid levels by losing weight. In addition, a reduced intake of fish, meat, and possibly beer may also lower uric-acid levels somewhat, but most people with gout need medication to reduce their uric-acid levels sufficiently.

Available for many years have been two types of medication that can lower blood uric acid. The oldest drug is probenecid (Benemid, Probalan), which works by increasing the excretion of uric acid in the urine. The other medication, allopurinol (Aloprim, Zyloprim), blocks the formation of uric acid by inhibiting the action of the enzyme xanthine oxidase.

The good news is that in February, 40 years after the last drug for gout was developed, the FDA approved a new drug, febuxostat (Uloric), which also inhibits xanthine oxidase. In several trials, this new drug was more effective than allopurinol in lowering uric acid levels. But more important than whether Uloric is more effective than the older drugs is that now another treatment option is available for those sufferers in whom the older drugs either caused side effects or failed to lower the level of uric acid sufficiently.

Of course, like all other medications, Uloric is associated with its own potential side effects—liver-function abnormalities, nausea, rash, transient joint pains, and possibly blood clots. You should discuss these side effects with your doctor, and the chance of adverse interactions with other medications you are taking before a prescription is written for this new drug.

It is also important to recognize that none of these medications that lower uric acid levels is effective in alleviating the symptoms of an acute attack of gout. Other medications are needed to relieve the pain and other manifestations of such attacks.