Traditionally, gout was associated with royalty because it is believed to be caused by a rich diet including cheeses, legumes and organ meats like kidneys.
But gout is not just for royalty anymore.
According to the United States government’s National Arthritis Data Workgroup, an estimated 6 million people in the United States report having experienced gout at some point in their lives. In fact, gout is the most common form of inflammatory arthritis in men over age 40.
Gout is a form of arthritis commonly found in the joint at the base of the big toe. If left untreated, the inflammation can become excruciating enough to impair walking, and can eventually damage other joints. It has also been linked to other medical conditions, such as kidney problems, diabetes and heart disease.
According to Dr. Martin Taubman, of Podiatry Associates of San Diego, gout is not a disease of age, but most cases are found in middle-aged people who have a low metabolism.
Dr. Theresa Cyr, of Theresa Cyr DO Medical Corp. in San Diego, said those at the greatest risk of getting gout are people who have a very poor diet.
The acute pain accompanying gout is caused by uric acid crystals, said Taubman.
“What happens is normally the uric acid crystals are dissolved in the blood and they get urinated out, but if a person has a problem — either hereditary or from some disease process — and is unable to dissolve those crystals and urinate them out through their kidneys … it can build up in the blood,” he said.
The crystals are heavier than blood, and can congregate in the feet, leading to a buildup at the base of the big toe.
Where does the overabundance of uric acid come from?
According to Taubman, it comes from food.
“Uric acid is a byproduct of various foods that contain purines, and normally these foods that have purines in them are broken down in the blood so that the uric acid dissolves in the blood,” he said.
Some foods high in purines include beer and other alcohol, anchovies, sardines, herring, yeast and several others.
“There has to be some sort of condition like an underlying inflammation that causes you not to be able to handle the purines in your diet, because our body makes purines every day, and about two-thirds of the purines that are circulating in your blood are actually not from the food that you eat, but made from the body,” said Cyr.
She said the underlying inflammation can be caused by poor diet in general — not just a diet high in purines, adding that gout can be prevented by finding the root cause of the inflammation, which hampers the body’s ability to eliminate purines, and correcting that.
When treating gout, there are two focuses, said Taubman: the immediate pain and the slow buildup of uric acid.
“We immediately treat it with anti-inflammatory drugs and then we choose a combination of drugs to stop uric acid formation and stop inflammation,” he said.
Taubman also advises patients to stop eating foods high in purines and to stay hydrated. He then refers them back to their primary care physician.
In severe, long-term cases, surgery is sometimes needed to fix in the joints by removing and replacing them with artificial joints.