FEATURE — For many years in Europe, gout, or the “gouge” as some called it, was thought to be a curse upon the rich in return for their enslavement of the lower classes who did their work but did not enjoy the fruits of their labors.
As the rich became older and richer, it seemed that a fair portion of them were plagued with a rapid onset, searing, swollen, red large toe, which was described as being so painful that even a bed sheet on it was unbearable. In Hippocrates day, the colchicum plant was known to be helpful for this disorder but was out of favor with the medical profession of the 1700s who felt that the appropriate treatment was to “bleed” the poor victim.
In retrospect, the common coincidences of the wealthy having enough money to dine regularly on kidney pie, lobster, and beef – all washed down with copious amounts of wine – while the poor laborers ate their garden vegetables and drank water for the most part are now recognized as the sources of whether one got gout or not.
As the eﬃcient body retrieves old and dying cells, it harvests the building blocks used to make new cells. These building blocks are known as purines. If the purines are, for various reasons, produced in excess or not excreted through the kidneys adequately, they form needle-shaped crystals called uric acid crystals. When the immune system recognizes these crystals piling up in a joint, an autoimmune attack is mounted with impressive inflammation of the joint.
Over time, it can cause severe destruction similar in appearance to rheumatoid arthritis. One of the common causes of overproduction of uric acid is alcohol intake and diets rich in purines, such as lobster and steak. You will remember the rich and their diets while the poor had very low purine diets.
One of the other problems is that sometimes we are not excreting the uric acid appropriately, and this is most often caused by other medications known as diuretics or water pills, such as those used to treat high blood pressure. There are some gene pools, such as the Polynesians, who lack an enzyme that breaks down uric acid into the purines to be used to make new cells, and the uric acid very often causes gout in this gene pool for no apparent reason.
A common myth about gout is the idea that a blood test for uric acid can diagnose or disprove this form of arthritis. In actuality, most patients having gout attacks have normal blood uric acid levels, and most patients with elevated blood uric acid do not get gout, though the risk for them of uric acid kidney stones is increased.
In the past, the only way to prove the presence of gout versus other arthritis forms was to painfully stick a needle into the sore joint, draw out some fluid and look for the uric acid crystals under a microscope. We are fortunate in our day to be able to see gout crystals in a joint with musculoskeletal ultrasound, which is painless.
There are many forms of eﬀective treatment of gout, and it is commonly thought of as the only truly “curable” arthritis. Of interest, one of the quickest acting medications is colchicine, which was used thousands of years ago by Hippocrates.
Gout can happen along with other forms of arthritis at the same time and is often confusing for the physician. We are fortunate to live in a day when so many options to treat gout are available to us.
One thing of note is to choose your weight loss program wisely. It is suspected that some of the popular low-carb diets have a high fat content and may promote hyperuricemia by stimulating fat-burning for energy, producing a state called ketosis. This problem may make the gout condition worse, especially in the initial phases of diet change and weight loss. Simple fasting or “crash diets” also can raise your uric acid level and make the gout condition worse.
Written by DR. JEFFREY L MATHEWS, Southwest Spine & Pain.
This article was first published in St. George Health and Wellness magazine.