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What to Do About Gout

THE “DISEASE OF KINGS” IS RISING AMONG THE REST OF US

A searing pain jolts you from your sleep. You throw off the covers and stare in shock at your inflamed foot — the big toe, red hot and swollen, feels as if it’s being stabbed by a thousand needles. What in the world happened? Did you somehow break your foot in the middle of the night? Did you dislocate your toe in your sleep? It may feel that painful, but the more likely explanation is gout.

An acute, inflammatory form of arthritis, gout attacks suddenly — in a toe, a foot, a finger or another joint — and with an intensity of pain that is hard to imagine until you’ve been there. If you’ve never had a gout attack, the mere threat should be motivation enough to keep your weight down and your diet in check.

No longer just a disease of kings

Long associated with the heavy-eating-and-drinking ways of aristocrats, gout was once known as “the disease of kings.” These days, it is a more equal-opportunity disease, and it’s on the rise. The percentage of Americans afflicted today — about 6 percent of men and 2 percent of women — is twice what it was 50 years ago, and is increasing steadily. The evidence suggests that this rise has a lot to do with our expanding waistlines.

Gout is related to elevated levels of uric acid, which is a byproduct of normal cell turnover and of the metabolism of certain foods. Normally, the kidneys remove uric acid from the blood. If too much uric acid builds up, however, the excess can collect and crystallize in the joints, triggering the acute inflammation that is a gout attack.

One common cause of high uric acid levels is over-consumption of meat and alcohol. Both contain high levels of purines, the compounds that convert into uric acid during metabolism. According to the United States Department of Agriculture, the average American ate 195 pounds of meat (red meat, poultry and fish) in the year 2000 — an increase of 57 pounds over the 1950s.

Another cause of elevated uric acid has to do with the kidneys. Their ability to eliminate uric acid can be impaired by all sorts of things, from medications to kidney disease and genetic conditions. One huge culprit is metabolic syndrome. Actually a group of conditions, metabolic syndrome is the term we now use to describe people who have high levels of belly fat, blood fat, blood pressure and blood sugar. All of these problems impair the kidneys’ ability to eliminate uric acid. Metabolic syndrome is the perfect setup for gout, and it’s rising sharply in the U.S.

A pain you can do without

No one who has ever had a gout attack will soon forget it. The pain can last anywhere from one week to several, but few people wait anywhere near that long to seek treatment.

In the midst of severe pain, the first priority is to stop the acute attack. Prescription NSAIDS (non-steroidal anti-inflammatories) usually provide relief within 24 to 48 hours. For people who can’t take NSAIDS, steroids or a drug called colchicine may offer effective alternatives.

Once the pain is quelled, other medicines, combined with lifestyle changes, can help prevent or reduce future attacks. Drugs that impair the body’s ability to make uric acid can reduce the frequency and severity of attacks. Another type of drug increases the elimination of uric acid, but this can’t be used by people who have had kidney stones or kidney disease. For those who take colchicine, continuing that medicine can help prevent future attacks, as well.

As with any preventable illness — and gout is one of the most preventable forms of arthritis — lifestyle changes are usually the best medicine to prevent gout in the first place. Avoiding alcohol and reducing meat in the diet are two excellent first steps. If weight is an issue, adding some daily exercise, cutting calories

and losing a few pounds can be hugely beneficial. (See page 8 for more advice about healthy weight loss.) I’ve seen it happen again and again: once people become lean and healthy, problems with gout — along with all of the risks and problems associated with metabolic syndrome — simply go away.