Gout: Rich man's disease no more (By April Chong)

The following was reported in Mind Your Body of the Straits Times dated 27 May 2010 by April Chong.

Gout: Rich man's disease no more

The painful joint disease used to strike only those who indulged in rich foods but now it afflicts people from all strata of society as more have access to good food
By April Chong

x---------------------------------------------------------x

Gout, known as the disease of kings or the rich man's disease, has had a long history - the Egyptians first wrote about gouty big toes in 2,600BC.

Today, however, the ailment is no longer confined to the nobility or rich.

Gout is a type of arthritis characterised by swollen, painful and red joints. While the base of the big toe is the most common spot, the feet, fingers, wrists, elbows, knees or ankles can also be affected.

This happens when the body produces too much uric acid or cannot get rid of the excess acid, which comes from the breakdown of purine.

Purine is a nitrogenous substance that forms part of the body's cells and is usually found in high-protein food.

If there is excessive purine in the blood due to too much purine-rich food, there will be excessive uric acid in the blood.

This leads to the deposition of its crystal in the joints and tendons, causing gout, said Dr Low Chee Kwang, an orthopaedic surgeon from United Orthopaedic Specialists.

The condition can be so serious that multiple joints can become swollen. There is severe pain, making walking or going to work difficult, said consultant rheumatologist Wei Howe Koh, who runs the Arthritis and Rheumatism Medical Clinic.

In some cases, patients can develop lumps of uric acid under the skin at the joints, known as tophi. These are generally painless, albeit unsightly.

The disease often recurs because many patients do not stick to their medication or diet, said Dr Wei.

More young people getting it

Gout is usually hereditary, although it can be exacerbated by a rich diet. Hence, not everyone with high uric acid levels will necessarily get gout unless he consumes excessive levels of purine.

For example, kidney patients, who tend to have high uric acid levels because their kidneys cannot handle its excretion, may not show symptoms of gout, observed Dr Angeline Goh, a consultant at Singapore General Hospital's renal department.

The risk of getting gout increases when one is male, overweight and over the age of 40, or when one has certain blood disorders like leukaemia or takes certain hypertensive medications.

Women are less likely to get gout because of the protective effect of the female hormone oestrogen. But the incidence of gout in women increases when they hit post-menopausal age, said Dr Wei.

It can be a lifelong problem if not tackled and excessive uric acid can get deposited in the soft tissues of the ears, hands and feet and the kidneys, leading to their blockage and renal failure.

Studies around the world suggest that more people are coming down with gout and that it is no longer a rich man's disease.

Gout affects about 1.5 per cent of people in Britain and 2 per cent in the United States. Statistics on the situation here are not available, although some doctors say there appears to be more young people seeking treatment for it.

They attribute this to increasing affluence, with more people having access to more food.

The availability of high-purine food such as sausages and fried chicken, as well as the fact that people are consuming more alcohol and ready-made sauces, are the main culprits, said Magdalin Cheong, the chief dietitian at Changi General Hospital's dietetic and food services.

It is no wonder that gout seems to be hitting a younger crowd as they turn to drinking and eating rich food and shun fresh fruit and vegetables.

Watch your diet

To keep gout at bay, drink plenty of water to dilute the uric acid and avoid alcohol and high-purine food like animal organs and shellfish, advised Dr Low.

A 2004 American study published in the journal Lancet found that men who drank two or more beers a day were 2.5 times more likely to develop gout than those who did not drink.

Another report published in the British Medical Journal in 2008 found that men who consumed two or more sweet soft drinks a day have an 85 per cent higher risk of gout compared with those who drink less than one a month.

While controlling the diet is important, doctors may prescribe anti-inflammatory drugs and drugs to control uric acid deposition.

There are are also alternative treatments for gout, including taking cherries, coffee or more vitamin C.

However, doctors say that those embarking on alternative treatments should do ample research, monitor the effects of such treatments and seek a qualified health professional's advice when in doubt.

Also, some other forms of arthritis can be mistaken for gout and vice versa.

For example, in pseudogout - literally false gout - calcium pyrophospate crystals are deposited instead of uric acid, leading to symptoms similar to gout, said

Dr Wei. In this case, trying to lower purine or uric acid levels in the body, or taking uric acid-lowering drugs would not have worked.

Gout is usually diagnosed by a blood test to measure uric acid levels or an analysis of the joint fluids to detect uric acid crystals.

Hence, seeking proper medical help is always important.