Not Just the KING’S DISEASE
Gout is painful and can affect anyone
For many centuries, people around the world have been affected by gout, the most common form of inflammatory arthritis. Gout occurs when excess uric acid builds up and crystallizes around joints and tendons. It can lead to incidences of extreme pain, tenderness and swelling. The big toe is most commonly affected, but pain can also be found in the joints of the feet, ankles, knees, wrists and elbows.
Dr. Gilbert Kepecs, division of rheumatology chief at Hackensack University Medical Center, explains what happens during a gout flare-up.
“If something disturbs the deposit, such as dehydration, minor trauma, an illness or surgery, the microscopic crystals enter the joint or tissue and are attacked by white blood cells, as if they were an infection,” he says. “The area swells, turns red and hot, and becomes extremely painful.”
For a long time, gout was referred to as the “king’s disease” or “rich man’s disease” because it was believed to be linked to the kind of overindulgence in food and alcohol that only the rich could afford. These foods and drinks were high in purines, which break down into uric acid.
Kepecs says this idea dates back to the 1700s. “If someone ate protein, such as meat, once a month during 1700s Europe, he was ‘rich,’” he says. “Our diet now is ‘richer’ than the nobility 200 years ago. Since uric acid is produced from purines, and we are consuming much more
protein-containing foods, the number of people with gout is increasing.”
According to Dr. David L. Arbit, division of rheumatology chief at The Valley Hospital in Ridgewood and a doctor at New Jersey Associates in Medicine in Fair Lawn, there are two types of gout: episodic and chronic.
“Gout can be episodic, associated with highpurine meals (like a Fourth of July picnic), or can be chronic, causing continuous and severe joint and kidney damage, as well as pain,” Arbit says.
With the upsurge of gout in recent years, osteopathic medicine doctors like Shruti Dhorajia, physician at Holy Name Medical Center in Teaneck, say there are many possible causes of increased uric acid.
“Chances of getting gout are greater in people who eat meat and seafood, which are high in purines; those who drink sweetened beverages and alcohol; people who are obese; have untreated blood pressure, diabetes, metabolic syndrome, and heart/kidney diseases; people who are on diuretics; those who have a family history of gout; men and post-menopausal females,” she says.
Dr. Ruth Christine Cholhan, rheumatology chief at Englewood Hospital and Medical Center and doctor at her own private practice, says gout has become more prevalent because of “increases in longevity, use of diuretics and low-dose aspirin, renal disease and hypertension.” She says the prevalence has doubled over the past 20 years.
Although all people produce uric acid, Kepecs says that some produce more than others. Congruently, some get rid of it more efficiently; genetic differences predispose the disease.
“Anyone with kidney disease will not get rid of the uric acid efficiently. Similarly, anyone with heart disease may not filter it properly,” he says. “Some medications, especially diuretics or ‘water pills,’ increase uric acid. Even ‘healthy’ foods such as lentils and fruits can increase uric acid in susceptible people.”
Dr. Michael Lewko, attending rheumatologist for St. Joseph’s Regional Medical Center in Paterson and head of the NJ Arthritis and Osteoporosis Center in Clifton, also believes there are many risk factors that lead to gout.
“It used to be blamed purely on an overindulgence of foods high in purines and beer, but anyone can get gout,” Lewko says. “It is more likely found in men because of their lifestyle. What they eat and drink may eventually lead to high uric acid.”
Lewko says incidents of gout increase for women once they reach menopausal age. “Estrogen has a beneficial role in terms of gout,” he says. “When women go through menopause, they produce less estrogen, which is very protective against gout as it clears out uric acid. I see gout in older women, specifically affecting osteoarthritic joints like their fingers.”
Because there are a number of factors that can lead to uric acid buildup, there are a variety of preventative methods to fight flares. Gout patients may be asked to adjust their diet or modify medications they take for other conditions. In some cases, medications will be used to treat gout.
“Some will treat the attack quickly, some prevent the body from reacting to the uric acid,” Kepecs says. “And, in most cases, we will use one of several medications to gradually reduce the body’s total uric acid.”
Although gout is treated on a case-by-case basis, doctors agree that controlling one’s alcohol consumption is a good place to start. Cholhan says she has found that alcohol definitely increases the risk of gout, as both increased uric acid production and decreased uric acid excretion by the kidney have been found in gout patients.