Your Mind & Body: Disease of the Kings

An estimated 6 million people in the United States have experienced gout at some point in their lives. Known as “the disease of kings and the king of diseases,” gout has been studied by physicians and has caused suffering in many people for centuries. Gout is a type of arthritis that occurs when uric acid builds up in the blood and causes joint inflammation. Men aged 40 to 50 are most commonly affected.

What causes Gout?

Gout is one of the few types of arthritis where the cause is known. It results from deposits of needle-like crystals of uric acid in the connective tissue, joint spaces, or both. Uric acid is a byproduct of the breakdown of purines or waste products in the body. Normally uric acid breaks down in the blood and is eliminated in urine. When the body increases its production of uric acid or if the kidneys do not eliminate enough uric acid from the body, levels build up. This is called hyperuricemia. If excess uric acid crystals form as a result of hyperuricemia, gout can develop.

What are the symptoms?

• Sudden, severe attacks of pain
• Tenderness
• Redness
• Warmth
• Swelling in some joints
• It usually affects one joint at a time, especially the joint of the big toe, but can also affect the knee, ankle, foot, hand, wrist and elbow.
• Deposits of uric acid, called tophi, can appear as lumps under the skin around the joints and at the rim of the ear.
• In addition, uric acid crystals can also collect in the kidneys and cause kidney stones.

How is it diagnosed?

Standard diagnostic tools for gout may include a medical history and physical examination, blood test for uric acid, and urine sample for uric acid. For a definitive diagnosis of gout, a sample of synovial fluid from the affected joint is required. X-rays may be helpful. Not everyone with high uric acid levels in the blood has gout.

How is Gout treated?

Indomethacin is the usual choice for pain relief during an acute attack of gout. Colchicine (Colcrys), a derivative of the autumn crocus, has been used to treat gout for hundreds of years. This drug relieves the pain and swelling and can help prevent future attacks. Corticosteroids such as Prednisone can also be very effective for short term relief of joint inflammation and pain.

Allopurinol blocks uric acid production and is the standard drug used in long-term treatment of gout. Probenecid is another maintenance drug that increases uric acid excretion in the urine. Febuxostat (Uloric) is the newest drug available to lower uric acid in the blood and has greatly improved the quality of life for persons with gout.

• Lifestyle and Dietary Recommendations
• Weight loss can help reduce uric acid levels in those people that are overweight.
• Drinking plenty of water also helps remove uric acid from the body.
• Avoid alcohol.
• Limit the amount of meat at each meal.
• Avoid purine rich foods – anchovies, sardines, fish roes, herring, yeast, organ meats (e.g., liver, kidneys), legumes (e.g., dried beans, peas, and soybeans), meat extracts, consommé, gravies, mushrooms, spinach, asparagus, cauliflower, and poultry.