Ouch from Gout – The Disease of Kings

Gout is a devil who typically pays his first visit early in the morning, kicking the victim out of sweet dreams by an attack of excruciating pain. The pain is usually from one of the joints in our legs, mostly the base of the big toe, and sometimes the ankle or the knee. It can feel like a monster grinding teeth there, or being burnt with an iron. Imagine how hot, red, swollen, and tender the affected joint is, and you don’t want to touch it with anything.

For thousands of years humans have gotten to know and fight with gout. Its historical name, the “disease of kings”, tells some of the risk factors, such as male, advanced age, and lavish consumption of red meat, seafood, and alcohol. Today many of us in developed countries are able to share the menus of ancient kings, and the devil of gout hears the summons. In fact, it is estimated that gout affects more than 8 millions of people in United States, almost 4 out of 100 adults.

Uric acid is the culprit chemical responsible for gout. Accumulation of uric acids in our body can result from either overproduction or impaired excretion. Beers, distilled spirits, sodas, corn syrup, and fructose-enriched juices promote the production of uric acids via metabolism. Medications such thiazides, Lasix, cyclosporine, tacrolimus, and aspirin can affect kidney function in removing uric acid from our body. Patients with obesity, hypertension, and chronic kidney disease, as well as recipients of organ transplant are more susceptible to gout. On the other hand, estrogen is a protective hormone. So women after menopause and men are at a higher risk than women at childbearing age.

Excessive uric acids form crystals and deposit in the joints, flaring up the unbearable inflammation, i.e. arthritis. These crystals are usually needle-shaped and can be seen under a microscope. They also have characteristic colors under polarized lights. In order to confirm the diagnosis of gout and exclude other potential causes of the arthritis, doctors would like to draw some fluid from the affected joint, and examine it for crystals, cells, bacteria, glucose, etc. Elevated uric acids in blood work can also support the diagnosis. X-ray of the affected joints sometimes show erosion of the bones.

The acute flare of gout usually reaches the maximal level of pain within 12-24 hours, and can resolves by itself in days to weeks. Anti-inflammatory drugs such as indomethacin and colchicine can be used to relieve the symptoms. For patients with peptic ulcers, kidney diseases, liver diseases, or using anticoagulants such as warfarin (Coumadin), injection of steroids into the joint may be a better option. If the high levels of uric acids remain, the devil will return to bite your joints again and again. With the crystals building up and the chronic inflammation damaging the cartilage and bones, some hard lumps called tophi can form around the joints. Medications reducing the production of uric acids, such as allopurinol and febuxostat, can slow down this process. However, lifestyle modifications are undoubtedly important. Vegetarian proteins from beans, eggs, Greek yogurt, cottage cheese etc. are more favorable than the red meat and seafood on the king’s menu. Dairy products with low fat are preferred. Vitamin C and maintaining a healthy weight are also found to be helpful.

Gout is not the only disease that can cause joint problems, but certainly an impressive one. Nowadays we have the knowledge that ancient kings lacked of. Work with your doctor, and you can shut the door on gout.

Dr. Ye is a resident physician who sees patients of all ages and provides obstetrical services at Lone Star Family Health Center, a non-profit 501©3 Federally Qualified Health Center operating facilities in Conroe, Spring, Willis, Grangerland, and Huntsville, and serving as home to a fully integrated Family Medicine Residency Program to increase the number of Family Medicine physicians for Texas and our community