Uric Acid and Gout

Gout: the disease of kings
Gout: the disease of kings (Photo credit: DanCentury)

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.

goutWhat 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.
How is it Diagnosed?

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.

Is it curable?

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.

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