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Dealing with the disease of kings

Drew Werner
Vail ÇO, Colorado

The disease of kings. It sounds rather noble, and certainly better than consumption, dropsy or one of the other diseases my grandmother remembers her older relatives having. While there is no doubt you would not want any of them, none is as painful as the Disease of Kings.

Dear Doc,

My husband’s big toe is so painful he can’t even walk. I’m suffering because of his suffering. I think his gout is back. What can he do?

” In Agony in Eagle,

Dear In Agony,

I have great sympathy for you and your husband. It is ironic that the King of Diseases causes so much suffering. If his big toe is red and hot, walking causes crippling pain and even the sheets touching his toes is unbearable, he very likely has gout. This affliction is more accurately considered an inflammatory or metabolic arthritis. In fact it is the most common form of inflammatory arthritis in men.

As many as 5.1 million people in the United States suffer from gout according to the National Health and Nutrition Examination Survey III. It strikes men three times more often than women. Gout is rare in younger men, but increases significantly after age 45. Women can get gout although it almost always strikes after menopause. Alarmingly, the incidence of gout seems to be increasing in the U.S. over the past decade.

Gout is an ancient disease and was accurately described by Hippocrates, the father of medicine, as early as 400 BC. He associated it with kings and nobility, which accurately reflected their indulgence in rich foods and meats. We now know that diets high in purines raise uric acid levels, which is the underlying cause of gout. Purines are found primarily in meats, although sardines, anchovies, seafood, and sugary soft drinks are all high in purines as well. Beer increases the risk of gout by 49 percent by drinking only 12 ounces a day, while liquor only raises the risks 15 percent and wine little if any. Although the cause is unknown, low-fat dairy products may actually reduce the risk of gout.

Obesity, high blood pressure, diabetes and hypothyroidism are common medical conditions which increase your risk of developing gout. If a family member has gout, your chances go up by 20 percent as well. Although some have linked gout to the spring season, it is more likely a reflection of poor hydration and warmer weather causing dehydration, which will also cause gout to flare up. Those flares are not soon forgotten, but the later effects of gout may be even more concerning.

Gout itself is caused by an elevation of uric acid in the body. Once uric acid levels climb above 7 mg/dL it precipitates much like too much sugar in a cup of coffee. The precipitated uric acid then forms crystals, which tend to collect in joints and cause the typical excruciating pain. Over time the crystals and resulting inflammation destroys the joints causing what may become a chronic debilitating arthritis. Even more worrisome is the recent well-studied link between elevated uric acid levels and vascular heart disease. Compelling evidence linking men with gout to an elevated risk of coronary heart disease was published in the magazine Circulation in August of 2007. Those same men had a higher rate of mortality from heart attacks, which raises the now pressing question whether elevated uric acid levels are actually a risk factor for coronary heart disease and heart attack.

If you have gout, you are in good company. Famous men from Henry VIII to Isaac Newton, Thomas Jefferson and Ben Franklin have suffered with it. Fortunately we now have much better treatment. Indomethacin, a prescription anti-inflammatory, is the drug of choice for an acute attack which affects the first joint in the big toe 75 percent of the time. This medicine needs to be carried with you as acute gout presents more quickly than our weather changes in the springtime. If you do not have Indomethacin, Advil will help as well as icing the painful joint. Prescription medications are used both in acute attacks and long term management. These may include steroids, colchicine, allopurinol and some others.

If you suspect you have gout, see your doctor not only for faster pain relief, but to check your uric acid levels. If they are elevated, weight loss, a low purine diet, and better control of your blood pressure are all important. If that is not enough, uric acid lowering medications may not only prevent another painful attack of gout, but may reduce your risk of heart disease and heart attack.

If you are still wondering about the not-so-noble sounding diseases of consumption and dropsy, they are what we now call tuberculosis and edema, often from heart failure.

Let me know what’s on your mind at cschnell@vaildaily.com. Remember your health is your responsibility! Health is our greatest asset and it doesn’t happen by accident. If something doesn’t seem right, or questions are left unanswered don’t wait, call your doctor.


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