Gout A disease of indulgence

Gout develops when the level of uric acid in the blood is
too high. In the past it was known as the patrician's
malady because it was considered a diseased of over
indulgence amongst the wealthy. High purine diet can affect
gout and red meat is high in purine. The rich ate red meat
while the poor could only afford grain.

Gout is predominantly a male disease up to the age of 50.
It starts around 30 and the peak is between 40 and 50
years. It is rare in pre-menopausal women. Hippocrates
wrote about gout as a disease of males and post-menopausal
women  and urate crystals were found in the big toe of an
Egyptian mummy.

Gout can be classified as primary and secondary. In primary
gout the body either produces too much uric acid or it
cannot excrete it effectively to maintain a normal blood
level. These patients benefit significantly from dietary
changes. Secondary gout develops as a result of other
factors. Some medical conditions can raise uric acid level
and trigger gout. These include renal disease and
myeloproliferative disorders. In leukaemia, the imbalance
is due to excessive production of uric acid, and in renal
disease the excretion of uric acid is impeded. Drugs can
affect blood uric acid levels. These include diuretics
especially thiazide diuretics, aspirin and cytotoxic drugs.
Gout is also linked to obesity and alcohol.

Acute gout usually develops during the night. 70-90% of
acute gout develops in the big toe and typically affects
the first metatarso-phalangeal joint. This is called
podagra. Within hours the pain becomes severe and
throbbing. The big toe swells up and can feel hot. It is
extremely painful to the touch and even the touch of the
bed sheath can induce excruciating pain. The acute episode
resolves on its own but can take over a week. Medication
can shorten this time.

Since the introduction in 1951 of probenacid and
allopurinol in 1963, chronic gout is rare apart from
non-compliant sufferers. Before these drugs were introduced
chronic gout caused severe distress amongst sufferers.
Acute gout was frequent and severe. In addition urate
crystals separated out into other joints, kidneys and other
organs leading to polyarthritis, kidney stones, heart
disease and tophi.

Diet and weight loss has an important role in gout
management. A low intake of purine can reduce blood urate
level by up to 20%. Foods high in purine are meat
especially liver and other organ meat, sausages and other
processed meat, seafood, milk, eggs and certain beans.
Alcohol increases the possibility of gout. Beer is the
worse culprit. It contains guanosine. This chemical is
converted by the gut flora into uric acid.

Today, with screening and tests done for insurance purpose,
we are seeing a group of individuals with high uric acid
without any signs of gout. These people need to be
monitored. Once all potential factors that can influence
gout are eliminated or reduced and diet and weight loss in
place, if the uric acid level remains high, then
maintenance therapy in the form of allopurinol is
recommended to keep the blood uric acid level within the
normal range. This stops urate crystals separating out into
important parts of the body.


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Dr.Phil Hariram is retired General Practitioner. He has
treated gout and arthritis for 27 years.
http://www.arthritissage.com
http://www.arthritissage.com/blog