"Old-Fashioned" Gout Is More Common Than Ever Today

A mature king feasting alone in a banquet hall

Gout was once known as “the disease of kings.” The iconic sufferer was the gluttonous Henry VIII, often pictured holding an entire turkey leg in one hand and a tankard of wine in the other. Some people speculate that Old King Hal’s increasingly irascible temper was caused in part by gout, a form of arthritis long associated with overindulgence, which causes attacks of intense pain in the joints.

Gout most commonly strikes the joints of the big toe. Other affected sites might include the ankle, heel, knees, wrists, fingers or elbow. And while some people think gout is an old-fashioned disease, The Centers for Disease Control and Prevention (CDC) says gout is on the rise today.

What causes gout?

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) explains that gout results when excess uric acid builds up in the bloodstream, caused by the breakdown of substances called purines, which are found in the tissues of our body and in some of the foods we eat. Normally, uric acid dissolves and passes out of the body. But if our bodies produce too much uric acid, or our kidneys don’t do a good enough job of getting rid of it, or if we eat too many foods that are high in purines, the uric acid can form needle-like crystals that are deposited in the joints, causing painful inflammation with swelling, redness, heat, stiffness—and by all accounts, a great deal of pain.

Though the causes of gout are more complicated than once thought, overindulgence in certain rich foods is still thought to be a factor. And today, we don’t have to be royalty to have access to those foods! Says a leading expert on gout, Dr. Hyon K. Choi from Massachusetts General Hospital, “Western lifestyle factors—including consumption of meats, fats, sugary sodas, and alcohol—and risk factors including obesity, hypertension and chronic kidney disease all contribute to the increased frequency of gout, which now affects more than 8 million in the U.S.”

Gout also runs in families; a person whose family members have it are more likely to also develop the condition. Some people have an enzyme defect that reduces their bodies’ ability to break down purines. And while gout is still more common among men, the rate is rising in women.

Our increased longevity is another part of the picture. A longer life gives gout more time to develop. And some of the medications more commonly taken by seniors are known to increase the level of uric acid in the body. Those drugs include diuretics, levodopa, cyclosporine and aspirin.

How is gout diagnosed?

NIAMS reports that gout can be difficult to diagnose. The symptoms can be vague and can mimic other diseases. Telltale signs include an attack of arthritis in only one joint, often the toe, ankle or knee. The attack often develops quickly, and the joint is swollen, red and warm.
To confirm the diagnosis, a doctor may insert a needle into an inflamed joint and examine the fluid for the crystals associated with gout.

Treating gout and preventing another attack

Gout is treated with medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and a drug called colchicine.

Lifestyle changes can also control recurrences of gout. These include:

  • Having the doctor review all medications the patient takes
  • Making dietary changes as recommended by the doctor
  • Getting enough exercise and maintaining a healthy weight
  • Reducing stress

Seniors may find it especially challenging to manage gout. The CDC reports that while gout typically strikes a single joint at a time in younger patients, it may affect a number of joints simultaneously in older patients. It might be harder for an older adult to get enough exercise and manage medications. But, say experts, it’s worth the effort, because people with gout can decrease the severity of attacks and reduce their risk of future attacks with the right treatment.

Dr. Choi, who also is a professor of medicine at Harvard Medical School, reports that many cases of gout go untreated, even though it is “essentially curable”—which is a shame, because, he says, “Advanced gout can be quite debilitating, as it leads to joint destruction and deformity, and acute gout flares are one of the most painful conditions experienced by humans. The pathogenesis of gout is well understood and effective treatments are available, but the care of gout remains remarkably suboptimal due to a lack of proper patient education and treatment mismanagement.”

Learn More

You can read more about gout on the websites of the Centers for Disease Control and Prevention (CDC) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

The information in this article is not intended to replace the advice of your healthcare provider.

Source: Assisting Hands Home Care in association with IlluminAge. Copyright © IlluminAge, 2017.