Gout’s Resurgence
By Lindsey Getz

The recent increase in the number of gout cases creates good reason to become educated on this troublesome disease.

While many people have heard of gout, the idea that it’s a “disease of the past” has made it one of those ailments about which most know very little. But older adults who suffer from this excruciating form of inflammatory arthritis know it’s a condition that warrants attention. In fact, gout has made a massive resurgence, and some studies even suggest the number of cases in this country has doubled in the last three decades.

Once called the disease of kings because of its association with living the high life, gout, as doctors know, can strike anyone, though it’s three to four times as common in men as in women. And there are certainly factors that put some at higher risk than others. While we know that it’s not just a rich man’s disease, it’s easy to understand the origin of this former belief.

 Modern research has demonstrated that overconsumption of luxury foods such as red meat, shellfish, hard liquor, and beer may increase the risk of a gout attack. The reason, explains Christopher Magee, MD, an orthopedic surgeon and the chief medical officer at Washington Adventist Hospital, is that these foods are rich in purines, chemical components that eventually become uric acid and, in cases of excess, can metabolize into crystals that settle into the joints and cause great pain.

In addition to being linked with eating purine-rich foods, gout is also associated with obesity in general, as well as with conditions such as diabetes, hypertension, and heart disease—all of which seem to be on the rise in America. “And there’s even been studies that show high incidence of gout in people who drink sugary beverages,” adds Magee. His reference is to a recent BMJstudy that found men who consume at least two soft drinks per day had an 85% greater likelihood of developing gout than those who drank less than one per month. In fact, even at lower levels, soda consumption increased the risk for gout in study participants.

Another potential cause of gout is kidney malfunction, which can result in a buildup of uric acid. And, like most diseases, there can also be a genetic component. In fact, one in four gout sufferers has a family history of it. “It may be entirely hereditary,” explains Magee. “It’s important that those with a family history of gout go out of their way to avoid foods that are high in purines and live a healthy lifestyle.”

While genetics have left some people predisposed to developing the disease, the resurgence of gout is likely linked to the way Americans live today. There is a lot of speculation that the rising number of gout cases may correlate with America’s obesity epidemic. It also happens to be a disease that affects older adults. “Because it occurs in the aging population, as more Americans get older, it makes sense we’re seeing more cases surface,” says Magee.

When Gout Strikes
Gout is most commonly known for causing sudden pain and swelling in the big toe. While that’s not the only place it can strike, about 90% of gout sufferers will at some point experience such pain and swelling in the big toe. Gout can actually affect any number of joints, including the knees, elbows, wrists, and those of the hands and feet. Symptoms include swelling and redness around the affected joint, sudden and severe pain, limited movement in the affected joint and, in some cases, a fever. In addition, as the crystals accumulate within joints, they can form tophi, or chalklike lumps and bumps that can actually become deforming over time. Once the gout attack subsides, it’s also possible for the skin around the joint to peel. An initial gout attack may last anywhere from three to 10 days.

While it may not always be possible to prevent gout, especially when it’s hereditary, there are ways to decrease the likelihood of an attack. According to Naomi Schlesinger, MD, chief of the division of rheumatology at the University of Medicine and Dentistry of New Jersey’s Robert Wood Johnson Medical School, losing weight or maintaining a healthy weight, eating a diet low in purine-rich foods and fructose, and treating underlying conditions such as hypertension and diabetes are effective preventive measures.

The emergence of a gout attack has also been associated with cold temperatures. “This may be one reason why it occurs in the joints of the big toe, which are the farthest away from the center of the body,” Magee hypothesizes. “Classically, an attack of gout comes on at night. Gout sufferers often describe episodes of waking up in the middle of the night with cold feet and a tremendous amount of pain in their big toe. It’s not proven as an effective preventive measure, but it can’t hurt to try and keep your feet warm during the night, perhaps sleeping with a pair of socks on.”

Keeping Gout at Bay
Besides making lifestyle changes to control gout, certain medications can ease the pain and help prevent future attacks. Nonsteroidal anti-inflammatory drugs, colchicine, and steroids have all long been used for gout treatment. However, the rapid reappearance of this disease has prompted many drug companies to scramble to improve on old treatments with stronger and more effective drugs. The medical field expects various options to arise in the near future. “There are many more treatments on the horizon,” says Schlesinger.

One drug that is now available after being approved in February by the FDA is febuxostat, marketed under the trade name Uloric. Schlesinger calls it an important drug that is helpful for patients with renal disease, which comprises a majority of gout patients.

Krystexxa, another new drug, will also likely be available soon. It has gone through the FDA process and was even recommended for approval by the committee but ultimately turned down because of concerns about the manufacturing process. While there has been discussion raised that Krystexxa may increase the risk of heart problems, it is said to be a drug that will bring relief for gout patients who have shown no previous improvement with other treatments or are unable to take alternative treatments for whatever reason.

As researchers continue to make advances toward better gout treatment, one of the most important roles that professionals can take for their patients is that of an educator. Since gout is not a disease of the past and is actually a very real modern-day concern, it will help to empower your patients with vital information. But first, it’s imperative to be self-educated. It’s important that individuals in positions to recognize the symptoms of gout, including those in various facets of the medical field, in social work positions, or involved with geriatric care, become more familiar with the disease. “Education is definitely important in making the right diagnosis and knowing the different treatment options available today,” says Schlesinger.

Becoming educated can help you better care for your patients by recognizing the symptoms early and helping prevent future attacks. Magee adds that the prevention of gout dovetails nicely with the prevention of many other chronic medical problems that are known to affect the aging population—obesity, cardiovascular disease, and diabetes, in particular. “It really comes down to weight control, balanced diet, and activity level,” he says. “These are three areas that should already be focused on to prevent other medical conditions in older adults. It’s interesting that the rise of gout has paralleled the rise of these other chronic diseases within our society, and it’s easy to link them all to being inactive, overweight, and making bad food choices. I think it’s important for people to recognize that a lot of these chronic medical conditions really have the same common genesis and require making the same lifestyle changes for better health.”

— Lindsey Getz is a freelance writer based in Royersford, PA.