Any joint can be affected by gout but usually it is one of the smaller joints of the foot. Classically, and in Punch cartoons, a big toe joint is attacked. The pain can be so severe that the patient is unable even to bear the weight of the bed covers, and may be forced, like a 19th-century squire, to spend the night in a chair with his foot resting on a stool. The pain, unless it is treated, continues unabated for about a week, during which time the patient is left hobbling.

Gout is the result of a build-up of uric acid in the bloodstream; this can lead to the deposit of sharp crystals in the joints. The resulting acute arthritis leaves the joint red and so swollen that the skin is shiny.

Gout may be triggered by an alcoholic binge (as appears to have been the case with our reader), or it may follow a very good dinner if this includes plenty of meat, especially red meat, game or shellfish. The amount of wine drunk is also relevant. Steak or venison doesn’t cause the gout — the basic cause is the hereditary biochemical abnormality that leads to the high uric acid levels. However, these triggers may reveal a weakness that would have stayed hidden if the sufferer had stuck to porridge and rice pudding. Other foods that also precipitate gout include strawberries, dried peas and beans.

A feature of gout is going without food, followed by a known trigger factor; the usual story is that a sufferer (almost always a man, or older woman) goes out to dinner having had neither breakfast nor lunch. By 6.30pm he is tired and hungry and the temptation is to have a quick drink or two before dinner. Retribution is swift and often during the following night the pain starts.

For those with recurrent gout, lesser indiscretions may cause minor pains in the joints of the feet or ankle the following day. These pains may not be severe enough to be a nuisance but are nevertheless a reminder of a tendency to suffer gout.

Roughly 150,000 people suffer from gout, and the numbers are increasing. The standard first-aid treatment is non-steroidal anti-inflammatory drugs (NSAIDs). I have found that the best is a COX-2, Arcoxia etoricoxib. When prescribing any NSAID it is essential to explain the relative risk. The COX-1 anti-inflammatories are the original NSAIDs and are more likely than COX-2s to cause gastro-intestinal problems. However, COX-2s are under suspicion for increasing a patient’s liability to cardiovascular disease, and some are no longer available.

If attacks of gout are at all frequent — for example, more than two a year — Zyloric allopurinol can be taken regularly to keep it at bay. Too many attacks of acute gout may give rise to a chronic gouty arthritis.

A Hertfordshire reader has asked if there was any risk in taking Fosamax to prevent, or treat, osteoporosis. She wondered if she should be concerned about a suit filed in Florida about its prescription?

Other readers have also asked about the piece in The Times (Business pages, April 13) about Fosamax, a bisphosphonate, and osteonecrosis of the jaw. Necrotic erosion of the jaw has been recorded in patients taking large doses of a very potent form of bisphosphonates, the group of drugs that Fosamax belongs to, when they have been used to treat bony malignancies.

Bisphosphonates have a beneficial effect on many of the women with breast cancer and secondaries in the bone. It is also possible that bisphosphonates might be efficacious — but there are no clinical trials to confirm or refute the suggestion — on men with bony secondaries of prostate cancer. In women the bisphosponates not only inhibit the extension of existing bony secondaries, but there is evidence of an anti-cancerous effect on the tumour cells.

Dentists were the first to notice that there could be the occasional link between taking bisphosphonates and jaw necrosis. As with most, if not all, drugs there are side effects. The art of medicine is to balance the benefits against the risk of adverse effects.

The only change during the past 30 years is that patients now expect to be warned and consulted about known side effects, and that lawyers have encouraged expensive litigation. Little is known about osteonecrosis of the jaw. It seems that this has affected between one in 1,000 and one in 10,000 patients taking bisphosphonates of one brand or another. The condition causes an area of necrosis (bone destruction), usually after tooth extraction and/or localised infection. This heals only slowly.

Would I take bisphosphonates? Yes, and in fact may soon do so. Would I take bisphosphonates if I “only” had incipient osteoporosis? Yes. Far more people are going to perish from the complications of osteoporosis than are in danger of developing an area of necrotic jaw.

Ask Dr Stuttaford

Send your questions to drstuttaford@thetimes.co.uk or to times2, The Times, 1 Pennington Street, London, E98 1TT. Please include the following: the symptoms (and how long they have been present), the person's age, sex and marital status. Dr Stuttaford's replies cannot apply to individual cases but should be taken in general context.