Gout is more than arthritic flareup
November 15, 2011
By Quinn Eddy
More than 8.3 million Americans are affected by gout.
A form of acute arthritis, gout occurs as a result of the body’s inflammatory reaction to needlelike crystals that form in joint fluid when there is an excess of uric acid in the fluid. Uric acid is a waste product of cell metabolism in the body.
Gout has been recognized and studied since the time of the ancient Egyptians. Hippocrates called gout the “un-walkable disease.” Galileo Galilei, Sir Isaac Newton and Charles Darwin all suffered from gout. In times when overindulgence and obesity was a rarity, gout was considered a disease of the rich and powerful and was frequently referred to as “the disease of kings.”
When these crystals appear in a joint, the joint and surrounding tissue become inflamed, leading to swelling and causing nerve endings in the area to become irritated, leading to intense pain. Occurring most commonly in the big toe, attacks are usually sudden and cause extreme and often debilitating pain. The pain is usually so excruciating that the sufferer cannot bear weight on the afflicted joint. The inflamed skin over the joint will appear red, shiny and dry.
‘As tender as an open wound’
Issaquah resident Brian Wall experienced his first gout flareup in his left big toe at age 38. Originally, he had thought he had sprained or broken his toe, but in a doctor’s examination he was found to have gout.
“It feels like a bunch of cut-up fish hooks in your joint,” Wall said. “I’ve had it so bad I’ve had to wear slippers to work. It gets to be so sensitive it hurts to even put a piece of ice on it. It’s as tender as an open wound. I’ve had my chest cut open for surgery and that wasn’t as painful as one outbreak of gout.”
Wall’s gout has spread to the top his left foot and knee. When experiencing an attack in his knee, Wall is crippled to the extent of needing crutches.
“Gout can certainly be dramatic when it hits, but it is one of the most gratifying conditions to treat because with available medicines it can be easily treated and with appropriate therapy, prevented from causing long-term damage,” said Dr. Philip Mease, director of rheumatology research at Swedish Medical Center. “It’s most often found in men, more often in lower extremity joints but can occur in other joints, such as the ankle, hand, wrist or elbow.”
Uric acid is found naturally in the blood stream and is formed as the body breaks down nutrients, mainly those containing purine. Purine is produced by the human body but is also found in high concentrations in certain foods, including organ meats, red meat, shellfish, dried peas and beans.
Even though gout is generally found in men age 45 or older, post-menopausal women bear nearly the same risk as men their age.
According to Mease, higher levels of uric acid exist in those who are obese, eat a poor diet, suffer from hypertension or experience poor kidney function.
“It’s people who live a rich lifestyle and indulge in less healthy diets of foods rich in purines, not adequately balanced by fruits, vegetables and grains,” Mease said.
If you have a family history of gout you may inherit gout genetically.
Medication, diet can help
Generally, the kidneys filter uric acid from the blood and excrete it in urine. Sometimes the body will produce more uric acid or the kidneys are less efficient filtering the substance from the blood. This results in a condition known as hyperuricemia.
When there are high levels of uric acid circulating in the blood, urate crystals may appear in joint fluid not unlike the sugar crystals that form around the lip of a syrup jar when the liquid portion of syrup dries, Mease said.
“The goal is to have the uric acid level below six milligrams per deciliter to avoid this crystallization phenomenon,” he said.
Being hyperuricemic doesn’t necessarily mean gout episodes will occur, but even if gout does not occur, very high uric aid levels can result in silent crystal deposition in the kidneys, contributing to impaired kidney function. Besides having a high uric acid level, certain traumatic events can bring on gout attacks, such as a major medical event like infection, surgery or the stress of hospitalization. Even a stubbed toe or a heavy drinking binge can spur inflammation.
“It’s not unusual to see levels of seven to nine fairly routinely,” Mease said. “Not all people with levels this high have attacks, but with the higher levels comes an increased probability an attack will occur.”
An attack of gouty arthritis may go away in a week and disappear for months but over the course of time attacks may recur more frequently, last longer and affect more joints.
Late-phase gout yields chronically painful, deforming and debilitating arthritis affecting many joints, and rocks of crystals known as tophi may develop near joints.
“Late-stage chronic gout can have a destructive effect on joints,” Mease said.
Anti-inflammatory medications such as ibuprofen should be taken at the first sign of a gout attack. Prescription medications that may be prescribed include prednisone or colchicine, both of which can also reduce inflammation and pain. If a patient has multiple attacks in one year, tophi or kidney stones, allopurinol or newer medicines such as febuxostat may be prescribed to decrease levels of uric acid in the blood in order to prevent recurrent attacks, formation of tophi and injury to the kidney.
“If these medications used to treat inflammation aren’t rapidly effective one can inject the joint with corticosteroids,” Mease said.
Corticosteroids give short-term pain relief and helps to reduce swelling and inflammation of the gouty joint.
Mease said gout is treatable and most physicians are well versed in the nuances of managing attacks.
“A good way to prevent gout is to eat a healthy, balanced diet and avoid obesity through regular exercise,” he said. “But if you are someone who is genetically programmed to have a high uric acid level despite excellent self care, the medicines we have available are highly effective and tolerated, so we should succeed in controlling the un-walkable disease.”