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Think You Have Gout? Here's What You Need To Know

Managing this painful form of arthritis is more about prevention than a cure.
PHOTO: istockphoto

Gout might be called the Disease of Kings, but rich men are not the only people who suffer from it. Studies in the U.S. and UK have indicated an increase in gout diagnoses across the board, including cases in people in their 20s and 30s. Even if most women of average to good health would not be at risk for gout until their 40s or 50s, males are suffer a higher risk at an earlier age.

And if you think this doesn’t affect you here and now, prevention can’t start too early—especially for something as painful as gout.

Keep reading to learn more about gout, for the sake of your own health and for that of your loved ones.

What is gout?

Gout is a type of inflammatory arthritis. This painful condition usually affects one joint at a time and occurs in bouts, or flares. Frequent flare ups may lead to gouty arthritis.

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“Gout is one of the common forms of arthritis that affects mostly young men but can affect anyone,” says Dr. Ronald Eullaran, a member and fellow of the Philippine Rheumatology Association and the section head of Rheumatology for Chong Hua Hospital in Mandaue City, Cebu.

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“Earlier description refers to it as the disease of kings because it is usually associated with good life. Most patients affected with gout have elevated blood uric acid levels, but not all patients with increase in uric acid will have gout. It usually involves the big toe but can affect any joints. Most patients afflicted by gout describe it as the most painful experience of their life.”

Causes of gout

The condition that causes gout, called hyperuricemia, refers to when there is excessive uric acid buildup in the body, either because your body is generating more of it or not getting rid of it efficiently.

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Hyperuricemia arises from too much monosodium urate (uric acid crystals) forming when the body breaks down purines, which occur naturally in the body but can also be taken in via the food you eat. Having this condition does not necessarily mean you have gout, and even if you do, you may not experience symptoms, especially in the early stages.

Acute gout flareups often occur at night; they often clear up on their own after several days but can be very painful while they last. These attacks can often be triggered by stress, other illnesses, or intake of alcohol or drugs.

Risk factors of gout

Gout is often called the Disease of Kings or the rich man’s disease because it was historically associated with overindulging in food and alcohol. It was also thought to be a condition that affected men more than women. But both these beliefs have since been challenged. While certain foods do make gout symptoms worse, overindulgence in general is not a direct cause for it. And while gout is most common in young men and older (postmenopausal) women, the past several years have seen an increase in cases with patients in their 20s and 30s.

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There are also other conditions raise your risk of developing hyperuricemia. Some of the ones identified by the Centers for Disease Control and Prevention (CDC) and National Institutes of Health’s (NIH) National institute of Arthritis and Muscoloskeletal and Skin Diseases (NIAMS) include:

  • Obesity
  • Hypertension (high blood pressure)
  • Congestive heart failure
  • Insulin resistance
  • Diabetes
  • Metabolic syndrome
  • Poor kidney function (renal insufficiency)
  • Hyperthyroidism
  • Psoriasis, hemolytic anemia

Other factors are more a matter of diet and lifestyle, such as:

  • Regular use of certain medications, such as diuretics, the vitamin niacin, and drugs containing salicylates like aspirin and Alka-Seltzers
  • Increased alcohol intake (since all types of alcohol are rich in purines)
  • A high-fructose diet
  • A purine-rich diet (high-purine foods include some types of fish and shellfish such as anchovies or crab, red meat, organ meats like liver or kidneys, mushrooms, asparagus, and so on)
  • Lack or regular exercise (which increases likelihood of obesity)
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Pre-menopausal women have a reduced risk for gout because until menopause hits, a woman’s body generate the hormone estrogen, which naturally causes uric acid to be flushed out in urine. After menopause, though, estrogen levels drop, and uric acid levels may start to rise as a result.

While gout is a genetic disease, it is greatly affected by environmental factors, especially diet and lifestyle, and can also be managed or prevented to some degree if you work to control these factors.

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Symptoms of gout

“The affected joint is usually swollen, tender, warm and associated with redness,” Dr. Eullaran says. “It is so painful that even contact with linen or blanket can trigger severe pain. The severity of pain is such that the patient will often seek hospital treatment.”

In women, gout tends to develop in the knees, toes, wrists and fingertips, reports the Arthritis Foundation. The condition so commonly affects the foot and especially the big toe, that the term “podagra” refers specifically to gout that affects the metatarsophalangeal joint between the foot and the big toe.

Joints with preexisting damage from osteoarthritis are also more likely to be affected by gout. For women, gout is also more likely to appear in multiple joints gradually rather than in sudden and severe attacks, which can lead to misdiagnosis of gout attacks as other conditions, such as inflammatory osteoarthritis.

Note that misdiagnosis of gout as another inflammatory disease is not uncommon since signs and symptoms of gout can vary and are not very specific. Also, according to the CDC, “Gout can only be diagnosed during a flare when a joint is hot, swollen, and painful and when a lab test finds uric acid crystals in the affected joint.”

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If you are worried you are experiencing an attack of gout, do a self-assessment to determine if the affected joint(s) is:

  • Painful
  • Swollen
  • Red
  • Warm
  • Stiff

Even if you are not sure you are experiencing gout, a trip to the doctor would help allay concerns.

When to see a doctor for gout

Dr. Eullaran recommends seeing a doctor at the first attack of gout. Even if you do not experience gout symptoms, he recommends having a doctor check you over if an increase in uric acid is detected in your blood. Patients can certainly expect tests to check for elevated uric acid, he says. “But it’s also nice to check blood sugar and cholesterol levels. Gout usually co-exists with hypertension, diabetes mellitus and dyslipidemia. Treatment of gout differs during acute attacks, during the asymptomatic, intercritical phase, and during the late stage we call chronic tophaceous gout.”

He stresses the importance of proper treatment and consultation. “This is a devastating disease if not properly managed. It can even lead to kidney failure.”

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Treatments or remedies for gout

There is no cure for gout, so once you are diagnosed, the key will be managing your pain, preventing future attacks, and preventing the conditioning from damaging your joints in the long term.

Medications doctors may prescribe include:

  • Anti-inflammatory drugs (NSAIDs) to reduce pain and swelling
  • Corticosteroids, which are anti-inflammatory hormones
  • Colchicine, which decreases swelling and lessens the buildup of uric acid crystals and which is best taken right after an attack
  • Xanthine oxidase inhibitors (XOIs) that limit the amount of uric acid your body creates
  • Uricosuric drugs that improve your body’s ability to get rid of uric acid

Certainly, your doctor will suggest lifestyle changes to keep flareups to a minimum.

How to manage gout

“Many [things], mostly, proper diet like low purine diet, avoid alcohol intake, weight loss and exercise, control of blood pressure, etcetera,” says Dr. Eullaran.

Most of the recommendations for living with gout or reducing your risk of developing gout, especially if you are genetically predisposed to it, have to do with diet and lifestyle. Here are the major ones:

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  • Avoid eating foods that are high in purines. These include:

    - Dried peas and beans
    - Organ and glandular meats such as beef kidneys, brains, liver, and sweetbreads
    - Gravy (which often is made using organ meats)
    - Game meats like veal or venison, although you should also limit serving sizes of red meats like beef, lamb, and pork
    - Mushrooms
    - Some types of fish like anchovies, codfish, herring, mackerel, and sardines
    - Some types of shellfish like crab, lobster, mussels, scallops, and shrimp

  • Reduce your alcohol intake—all alcohol is rich in purines; distilled liquors and beers are especially associated with increased risk of gout and recurring attacks, although you should be safe with low to moderate wine consumption
  • Lose weight, if you are overweight—besides dietary considerations, this also reduces the stress on your joints
  • Limit your intake of high-fructose/sugary foods like sweet fruit juices, sweetened cereals, candies, and so on
  • Increase the complex carbohydrates in your diets, such as fruits, vegetables, and whole grains
  • Hydrate well and regularly
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“It’s a combination of nurture and nature,” says Dr. Eullaran, “so if [you are] genetically predisposed, lifestyle modification will greatly help.”