Many suffer needlessly with this extreme form of arthritis

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Gout. It is one of the oldest diseases on record — the ancients wrote about it in 5 B.C. — yet most people today know little about it. Worse, they think they have to live with it.

"Seniors should know that gout should not be tolerated," says Dr. N. Lawrence Edwards, vice chairman of the Department of Medicine at the University of Florida, and chairman and CEO of the Gout & Uric Acid Education Society.

"People think those who get this are overeaters or over-drinkers. Most are just everyday people born with a predilection," he says.

The good news about gout is that within the last decade new drugs have come on the market that treat gout more effectively with fewer side effects than those of the past, Edwards says.


What is gout?

Gout is essentially an extreme and sudden form of arthritis. Though arthritis can have many causes, gout has only one — the buildup of uric acid in the body.

Uric acid is a normal waste product that results from cells dying and releasing purines, an organic compound. (The body also absorbs purines contained in some foods.) Normally, uric acid is excreted in the urine, but may build up in the body for a number of reasons. When uric acid levels get high, the acid forms crystals that collect in the joints, causing severe burning pain seemingly out of nowhere.


Why the big toe?

Gout typically manifests in males in their 40s or 50s, often in the big toe, Edwards says. Crystallization is temperature-dependent, which is why more than half of the first episodes of gout occur in the metatarsophalangeal joint of the big toe. The cooler temperatures in our extremities, particularly feet and toes, hasten crystallization.

Women are thought to be somewhat protected from gout by estrogen. That explains why they tend to have gout later in life and less often than men, according to the Gout and Uric Acid Education Society.

No laughing matter

Gout is more than a painful inconvenience. If left untreated, high uric acid levels can lead to kidney stones or deforming and disabling arthritis. Approximately one out of five gout sufferers — generally those who poorly control the disease — will develop kidney stones, according to the society.


How do you know if you have gout?

"The disease itself is not subtle. It is the most painful of the arthritises," Edwards says. Often you can't walk at all during the flare-up."

So, if you wake up with your big toe (or any other joint) on fire, go to the doctor and ask to have your uric acid levels checked. This is a simple blood test.

Edwards also recommends asking for the test if you have a risk factor for gout. According to the Gout and Uric Education Society, risk factors include: obesity, untreated high blood pressure, diabetes or high cholesterol, high levels of serum triglycerides in the blood, joint injury, taking diuretics, chemotherapy, kidney disease, taking Cyclosporine (an anti-rejection transplant medication), high intake of high fructose corn syrup (particularly in carbonated beverages), and heredity.


New drugs for gout

Gout can be treated and future attacks prevented by medication that reduces uric acid levels. The drug that was used for years was allopurinol (brand names Lopurin, Zyloprim) but some people had allergic reactions to it, Edwards says.

Newer drugs include febuxostat (brand name Uloric), which helps prevent uric acid production. Edwards says a patient might expect to take this for the rest of his or her life.

Pegloticase (brand name Krystexxa) breaks down uric acid to a more soluble and easily eliminated compound. Edwards says this drug is used in difficult gout cases or in medically complicated patients.

You do not need a specialist to treat gout. Edwards says 95 percent of all patients with gout recieve follow-up care with their primary care physician. "When you get into severe and advanced types of gout, it is important to go to a rheumatologist," he says.


Gout is on the rise

If you do have gout, you are part of a growing trend. There are an estimated 8 million people with gout in the United States today and the numbers are increasing here and worldwide, Edwards says.

There are a number of reasons for this, and obesity tops the list. "A lot of things that cause obesity decrease the clearance of uric acid by the kidneys. The widespread use of high fructose corn syrup in beverages is a marker," he says. "There are other medical reasons such as widespread use of low-dose aspirin and high blood pressure medications."

The best way to avoid gout?

In short, lose weight and watch your diet. And get uric acid levels tested if you have risk factors.

Copyright © 2014, Los Angeles Times
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