You probably think you need to be royalty like King Henry VIII of England to have gout. Not so! About two per cent of Canadians have gout, and even that number may be under-reported because gout is often mistaken for other types of joint pain, leading many people to just treat it themselves with a pain reliever.
It is true that more men than women are affected, yet by age 50 this difference disappears.
Gout or gouty arthritis is a type of arthritis, with joint inflammation affecting often the big toe, but also potentially the ankle, foot, knee, hand, wrist, and/or elbow.
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The inflammation is caused by deposits of uric acid crystals in the joint. It is thought that these joints are more often affected because they usually are cooler in temperature, which allows for uric acid deposits.
Gout’s association with the rich and famous was historically due to the different diets of rich versus poor people. The wealthier you were, the more likely you were to eat foods that produce uric acid when digested. Today, diets are much more similar regardless of income, meaning gout can affect anyone.
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However, some foods do seem to be more strongly implicated in gout. These are foods high in purine which is broken down in your body to uric acid. Such foods include red meats, seafoods, and organ meat such as kidneys and liver.
While your wealth is no longer a risk factor, there are others. Higher alcohol consumption (that is more than one drink per day for women or two for men) seems to be associated with a higher rate of gout.
As well, more people with untreated or poorly controlled high blood pressure, high cholesterol levels, or diabetes have gout. A family history of gout and existing osteoarthritis are also considered risk factors. And, some high blood pressure medications and low-dose ASA used for heart health can worsen gout.
Uric acid can be measured with a blood test. In general, with high uric acid your risk for gout increases. However, some people never are affected despite high uric acid levels.
Gout is a condition that flares up from time to time, with symptoms occurring, then diminishing and not recurring until months or even years have passed.
The pain is usually sudden and intense, and seems to occur most often at night. There may as well be joint swelling, redness and tenderness.
For acute attacks of gout, a non-steroidal anti-inflammatory drug is most often used, for example naproxen, ibuprofen, or diclofenac. Treatment is used until the symptoms have disappeared, usually in five to 10 days.
Sometimes, if the inflammation is severe, a steroid is needed but again only for a short time. Colchicine was at one time used widely, but today its gastrointestinal side-effects such as nausea, vomiting and diarrhea have limited its use.
Your body is also able to manufacture uric acid, and this process may itself be the reason for your higher levels. Allopurinol interrupts a crucial step, inhibiting an enzyme known as xanthine oxidase which is needed for the manufacture of the uric acid.
If you are prone to gout and have more than just occasional attacks, regular daily use of allopurinol may be a good idea. In general it is well tolerated and available in a variety of strengths, although a skin rash allergy is possible.
In the case of gout, making sure that you have a good fluid intake, especially water, is key.
Water helps wash excess uric acid from your body. Just think, if King Henry VIII drank more water and less alcohol along with saying, “No thank you,” to steak and kidney pie, he might not have had those painfully swollen joints!
Marie Berry is a lawyer/pharmacist interested in health and education.
