Aging Population - And Alcohol Use - Contribute To Rising Cases of Gout
by Ling Xu, M.D.
Gout is on the rise in the U.S., and this painful form of arthritis caused by needle-like crystals – monosodium urate – deposited into the joints, currently affects more than 2 million people – a two-fold increase over the past 20 years. It is related to the increasing prevalence of obesity, metabolic syndrome, hypertension, end-stage renal disease (ESRD), organ transplantation, and increased use of medications that can elevate urate levels, such as diuretics and low-dose aspirin.
The greatest increase in gout prevalence in the U.S. in recent years has been in patients 65 years and older. While men are more likely to have this condition than women, females become increasingly susceptible to gout after menopause.
Painful gout attacks result from inflammation caused by deposits of needle-like crystals in connective tissue and/or in the fluid that cushions the joint (synovial fluid). These crystals are made up of uric acid, a waste product produced during the natural breakdown of purines, which are part of all our body’s cells, as well as many of the foods we eat.
Heavy consumption of purine-rich foods, including red meats, fatty seafoods (like salmon and tuna) and some vegetables (spinach, asparagus, beans and mushrooms), particularly with concurrent alcohol intake, has long been associated with gout.
Uric acid is carried through the bloodstream to the kidneys where it is eliminated through urine. However, if the body produces too much uric acid and the kidneys don't eliminate enough of it, it will build up in the blood. If the uric acid crystalizes, a painful gout attack can occur at any time.
Unlike the chronic or dull ache that accompanies degenerative arthritis, gout attacks suddenly and without warning, producing severe pain as well as external redness, swelling and tenderness in the affected joint. Typically, gout affects the big toe (the podagra), but it can affect other joints in the ankles, knees and hands.
Alcohol consumption increases urate re-absorption through the kidneys while interfering with urinary urate secretion. Men who drink two or more 12-ounce beers daily as well as those who consume four or five drinks per day are at increased risk for acute gout.
The treatment for gout is twofold: acute attacks must be terminated with nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen, naproxen and colchicine. If only a single joint is affected patients can be treated with local steroids.
To prevent further attacks either low-dose anti-inflammatory agents or, ultimately getting rid of the excess uric acid are considered. The current medications include uricosurics, which reverse the basic abnormality (renal excretion), and allopurinol, which blocks the production of uric acid.
Because it can be as debilitating as rheumatoid arthritis, patients with gout symptoms should not hesitate to consult with their physicians and follow their recommendations for treating this painful recurring condition. Lifestyle modifications, including dietary intervention, weight loss and reduction of alcohol can significantly lower uric acid levels and the risk of developing gout.
# # #
Dr. Xu is board-certified in internal medicine and is affiliated with Eden Medical Center. Her office is located at 20130 Lake Chabot in Castro Valley. She can be reached at (510) 690-9360.