Do you have swollen joints and sometimes can’t keep up walking because of swollen toes? Do you suffer from excruciating pain especially during the night when it’s colder? If you do, then you are in the same league with the likes of Henry VIII, Kublai Khan, Nostradamus, Queen Anne, Isaac Newton, Gottfried Leibniz, Charles IV and Charles V, Pablo Neruda, Thomas Jefferson, Karl Marx, Benjamin Franklin, Henry James, Frederick the Great, Don Nelson, and even Jared Leto, All these people are known to have suffered the king’s disease, or more aptly known as gout.
Not only would you bear the pain (imagine being dabbed with a millions of tiny white-hot needles) and its physical manifestation (oh, the frustration of not being able to wear those pretty or dapper shoes because you have swollen toes!) , but when gout remains untreated, or if it becomes recurrent, you might also suffer from its complications –chronic pain and disability, kidney stones and even cardiac problems . Not cool.
The disease has long thought to be caused by overindulgence with food and alcohol, which during the early times can only be afforded by the rich and kings, hence the monikers “rich man’s disease “ and “king’s disease”. But in reality, gout affects people of different social and economic background. In the U.S. alone, over a million — most of them men –have been affected by this disease. The disease occurs within the age range of 40-50, but it can happen before or earlier. Women, seldom get affected but when they do, it is most common during their late 40’s and onwards.
What causes gout? The human body produces purines and we also ingest this substance by eating certain foods. When we get so much uric acid (a condition called hyperuricemia) but the body cannot eliminate it, gout may occur. The excess uric acid crystalizes and deposit themselves in the joints. Gout is most noted to initially manifest in the big toes, but it can also strike the knees, ankles, foot, hands, wrists, fingers and elbows.
Mainly, gout is caused by the overproduction of uric acid and under elimination of it by the human body. This phenomenon will be evident once the symptoms manifest, but it is not difficult to spot the most likely candidates.
Who are at risk?
- Eighteen percent of those who suffer from gout have a family history of the disease, so if your relatives have it, you are highly predisposed to it.
- Men are more prone to gout because of the natural level of purines in their body, although women may also get affected most likely at their menopausal stage, when their purine levels get as high as men’s.
- People who drink are also candidates as alcohol interferes with the elimination of uric acid.
- Being overweight would make one prone to excess uric acid as there is more tissue available for breakdown.
- People whose diet compose of high purine foods such as seafood (herrings, mussels, sardines, trouts, scallops, anchovies), internal organs (hearts, liver) yeast, sweetbreads, goose, turkey , etc.
- People with enzyme defects that interfere with the way the body breaks down purines.
- People with certain conditions that take medication that may increase the production of uric acid (e.g. diuretics that are used to treat hypertension)
- People with exposure to lead (Pb) may develop gout.
A person with hyperuricemia may not necessarily develop gout, and some people confuse gout with other rheumatic diseases such as arthritis and osteoarthritis as these are conditions that also affect joints and have the same symptoms. While gout is caused by the under-elimination of uric acid, the latter is caused by the wear and tear of the joints. Most naturally, the diagnosis and treatment would not be the same. To diagnose gout, a doctor may extract samples of synovial fluid from an inflamed joint using a needle, which then will be examined by a laboratory technician. The presence of monosodium urate crystals indicate gout, but their absence does not rule out the diagnosis.
Just because you don’t feel it doesn’t mean you don’t have it.
There are four stages of this disease. The very first stage of gout is Asymptomatic hyperuricemia. This is when a person has elevated level of uric acid in the blood but has not experience the painful symptoms yet. At this stage, treatment is not yet required.
Acute gout/acute gouty arthritis – the uric acid crystals are already deposited in the joints, which may cause swelling and intense pain with heat dissipating from the affected area. Intake of alcohol or drugs or even stressful events may trigger the attack. The first attack may last from 3 to 10 days, or sometimes it can be longer. Depending on your tolerance to pain, medication may not be necessary.
The third stage is in the interval/internal critical gout wherein the person does not experience any painful attacks and will have normal joint functions. The next attacks after the first one may occur after 6 months to two years, but the gap could take up to ten years. As strange as it may seem, even though one does not feel any symptom, attacks in this stage will be far more serious than the initial ones and the affected parts may move from the toes up to the Achilles area.
The scariest of all , the Chronic Tophaceous Gout or PolyarticluarGout, is the most disabling stage of gout. Permanent damage has affected the joints, and sometimes , the kidneys. Bumps and nodules may appear on the surface of the skin and pus may even exude from them. The good news is, with proper treatment, most people don’t develop into this stage.
Fortunately, gout is curable and can be treated. The treatments are designed to – minimize the pain, avoid future attacks, and avoid the formation of tophi (deposits of urate on a joint) and kidney stones. To alleviate the pain during attacks, a patient will be most likely be advised to ingest nonsteroidal anti -inflammatory drugs or use corticosteroids, which can be taken orally or can be injected into the affected joints.
How to keep up when you’re already suffering from gout.
Acute gout is best treated once you feel its symptoms. If you’re advised of medications, ensure that you take them on time and that you follow the instructions religiously. Doing this keeps the disease at bay , and will prevent future attacks.
Exercise regularly and maintain a healthy weight. Don’t go on extreme diets to lose weight as this may also increase the uric acid level in the blood.
Eat a healthy and balanced diet. Purine is found in all protein-foods and it is not recommended to forego all purine foods, so just avoid the ones that are rich in purine. Or if you must, ensure that you take drink a lot of fluids, particularly water. It helps remove uric acid from the body.
Follow up appointments with your doctor to evaluate your progress. Be honest about all the medicines and dietary supplements that you’re taking. If there’s anyone who can determine if you’re a high-risk for this disease, it’s your doctor.