Not Just the KING’S DIS­EASE

Gout is painful and can af­fect any­one

201 Health - - Arthritis - WRIT­TEN BY TARA HOPFENSPIRGER

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.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.