Gout is sometimes referred to as the “disease of kings” because it long has been associated incorrectly with the kind of overindulgence in food and wine only the rich and powerful could afford. In fact, anyone can be affected, and the risk factors are varied. Fortunately, it is possible to treat gout and reduce its agonizing attacks by avoiding food triggers and taking advantage of medication options.
Gout is a painful and potentially disabling form of arthritis that has been recognized since ancient times. Initial symptoms usually consist of intense episodes of painful swelling in single joints, most often in the feet (especially the big toe). Treatments are now available to control most cases of gout, but diagnosing this disorder can be difficult, and treatment plans often have to be tailored for each person.
Gout occurs when excess uric acid (a normal waste product) accumulates in the body, and needle‐like crystals deposit in the joints. This may happen because either uric acid production increases or, more often, the kidneys are unable to remove uric acid from the body adequately. Certain foods, such as shellfish and alcohol, may increase uric acid levels and lead to gout attacks. Some medications also can increase uric acid levels. Examples of such medications include moderatedose aspirin (81 mg used for prevention of heart attack and stroke has minimal effect and can generally be continued), diuretics such as hydrochlorothiazide (Esidrix, Hydro‐D), and immunosuppressants used in organ transplantation such as cyclosporine (Neoral, Sandimmune) and tacrolimus (Prograf).
With time, increased uric acid levels in the blood may lead to deposits of monosodium urate crystals in and around the joints. These crystals can attract white blood cells, leading to severe, painful gout attacks. Uric acid also can deposit in the urinary tract, causing kidney stones.
Gout afflicts up to 3 million Americans. This condition and its complications occur more often in men, women after menopause, and people with kidney disease. Gout is strongly associated with obesity, hypertension, hyperlipidemia and diabetes. Because of genetic factors, gout tends to run in some families.
Gout affects quality of life both by the episodic attacks and potential for chronic arthritis. Compliance with medical regimens is critical. Lifestyle changes may make it easier to manage this lifetime disease. Suggestions include gradual weight loss, avoidance of alcohol and, reduced consumption of fructose‐containing beverages and foods and foods high in purines.