Arthritis For Dummies. Barry Fox
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Not Just for Royalty
Many people think that gout is a disease reserved for corpulent kings and beefy barons, but any one of us can be stricken, even if we’re slim and never drink alcohol.
Summarizing the symptoms
More than eight million Americans suffer from gout. In younger populations, gout affects men more often than women, but women catch up to them after menopause. Officially known as acute gouty arthritis, the problem usually begins with a sudden, overwhelming “assault” on a joint. You may go to bed feeling fine with no inkling of trouble ahead only to wake up in the middle of the night with excruciating pain in the “bunion joint” of your big toe. The joint is stiff and warm to the touch, and swelling lends a shiny, tight, reddish or purplish look to the skin, which is tightly stretched over the area. Sometimes the joint is so inflamed and tender that even the touch of a bed sheet causes agonizing pain. You may also have a fever, chills, a rapid heart rate, and a general blah feeling.
Gout is linked to excess levels of uric acid in the blood (known as hyperuricemia). When the blood has more uric acid than it can handle, the body may convert the excess into sharp, pointed urate crystals and store them in one or more joints. Since these urate crystals don’t belong in the joints, the immune system tries to clean them up, resulting in pain and inflammation. See Figure 4-1 for an example of what these crystal deposits look like in a joint.
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FIGURE 4-1: Crystal deposits in a gouty joint.
The joint at the base of the big toe is quite often the first site that gout strikes. The elbows, wrists, fingers, knees, ankles, heels, and instep may also be attacked during the first or subsequent bouts, while the shoulders, spine, and hips are rarely touched. No matter where gout strikes first, there’s about a 75 percent chance that it will affect the big toe at some point.
Your first attack of gout may also be your last. Or, it may herald the beginning of a series of attacks on that joint and/or others, leading to progressive and irreversible joint injury. Fortunately, medical treatment can help ward off recurring attacks while preventing or minimizing permanent joint damage. In this sense, gout is really the only curable form of arthritis — so long as you take your medicines as directed every day! If you want to guard against gout, your best strategy is probably to be born female. Women’s uric acid levels are naturally lower than men’s until they reach menopause. Then their uric acid levels start to rise, although it can take up to 20 years before they equal the levels seen in men.
Several situations are linked to an excessive amount of uric acid in the blood, including the following:
Genetics — Approximately 20 percent of those with gout have a history of the disease in the family.
Taking drugs that can lead to increased uric acid (such as diuretics, aspirin, nicotinic acid, levodopa, and cyclosporine).
Blood cancer or other diseases that cause the rapid multiplication and destruction of body cells, leading to higher levels of purines and uric acid.
Chronic kidney disease which hamper the kidneys’ ability to filter out uric acid.
Drinking too much alcohol (beer or grain liquors, including whiskey and vodka) and/or eating or drinking foods that contain high-fructose corn syrup may also play a role in initiating gout.
To a lesser extent, eating lots of foods containg a high amount of purines such as red meat, lamb or pork, organ meats, shellfish, and certain fish (including anchovies, sardines, mussels, codfish, and herring), may stimulate the body’s production of uric acid. Gout is also associated with high blood pressure, heart disease, diabetes, high levels of cholesterol, and obesity.
Though the disease becomes apparent when excess uric acid in the blood is converted into a crystalline form and deposited in the joints, elevated uric acid alone doesn’t cause gout. Many people with excess levels of uric acid never get the disease, while others who suffer from terrible gout-related pain may have fairly standard amounts of uric acid. It’s also possible to have fully formed uric acid crystals deposited in a joint or two yet feel no pain at all.
Diagnosing and treating gout
Sometimes the symptoms of gout “speak” loudly, making diagnosis fairly easy. Other times, they can be vague, making diagnosis a real head-scratcher.
Gout is curable with medications, so long as you take them daily and your doctor adjusts the dosage of your medication to ensure that your uric acid levels stay below a certain threshold.
For treatment of a gout flare, high doses of NSAIDs (see Chapter 8) are used to ease pain and inflammation.Steroids may also be injected directly into the joint to reduce inflammation, and your doctor may insert a needle into the joint and draw out the excess joint fluid to relieve the pain and pressure.
If you have more than two gout flares per year, you have tophi, and/or an X-ray shows that your have permanent joint damage due to gout, your doctor will likely recommend chronic urate lowering therapy (for life), using a medicine such as allopurinol or febuxostat that lowers uric acid to levels where crystals cannot form.
Helping yourself heal
You can help heal gout and prevent its recurrence by:
Losing weight if you are overweight
Eliminating alcohol intake, especially beer or grain liquors, which contain purines
Eliminating foods containing purines (detailed earlier in this chapter)
Working with your doctor to keep your blood pressure under control, if it’s a problem, as well as heart disease and/or diabetes
Consulting with your doctor to make sure you’re not taking any medicines or supplements that encourage gout or interfere with your treatment
Exercising regularly
Studying Pseudogout: The Royal Pretender
Although gout is an ancient disease that has ruined many a day in a medieval VIP’s life, pseudogout is a relatively “new” affliction. Although it’s probably been around as long as “regular” gout, doctors didn’t realize it was a separate problem until it was first described in 1962.
Summarizing the symptoms
The symptoms of pseudogout are similar to those of gout but without the needlelike uric acid crystals in the joint. Instead, pseudogout is characterized by rhomboid-shaped crystals