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Gout – Rich Man's Disease No More   

  Source: The Straits Times – Mind Your Body. By: April Chong  

Gout, known as the disease of kings or the rich man's disease, has had a long history – the Egyptians first wrote about gouty big toes in 2,600BC. Today, however, the ailment is no longer confined to nobility or the rich.

Gout is a type of arthritis

Gout is a type of arthritis characterised by swollen, painful and red joints. While the base of the big toe is the most common spot, the feet, fingers, wrists, elbows, knees or ankles can also be affected. This happens when the body produces too much uric acid or cannot get rid of the excess acid, which comes from the breakdown of purine.

What is purine?

Purine is a nitrogenous substance that forms part of the body's cells and is usually found in high-protein food. If there is excessive purine in the blood due to too much purine-rich food, there will be excessive uric acid in the blood.This leads to the deposition of its crystals in the joints and tendons, causing gout.

The condition can be so serious that multiple joints can become swollen. There is severe pain, making walking or going to work difficult. In some cases, patients can develop lumps of uric acid under the skin at the joints, known as tophi. These are generally painless, albeit unsightly. The disease often recurs because many patients do not stick to their medication or diet.

Who is at risk?

Gout is usually hereditary, although it can be exacerbated by a rich diet. Hence, not everyone with high uric acid levels will necessarily get gout, unless they consume excessive amounts of purine. For example, kidney patients who tend to have high uric acid levels because their kidneys cannot handle its excretion, may not show symptoms of gout, observed Dr Angeline Goh, a consultant at Singapore General Hospital's Department of Renal Medicine.

  • The risk of getting gout increases when one is male, overweight and over the age of 40, or when one has certain blood disorders like leukaemia, or takes certain hypertensive medications.
  • Women are less likely to get gout because of the protective effect of the female hormone oestrogen. But the incidence of gout in women increases when they hit post-menopausal age.

Gout affecting more young people

It can be a lifelong problem if not tackled properly, and excessive uric acid can get deposited in the soft tissues of the ears, hands and feet, and the kidneys, leading to their blockage. It can even result in renal failure. Studies around the world suggest that more people are coming down with gout and that it is no longer a rich man's disease. Gout affects about 1.5 per cent of people in Britain and 2 per cent in the United States. Statistics on the situation here are not available, although some doctors say more young people seem to be seeking treatment for it.

They attribute this trend to increasing affluence, with more people having access to high-purine foods. The availability of high-purine foods such as sausages and fried chicken, as well as the fact that people are consuming more alcohol and ready-made sauces, are the main culprits, said Magdalin Cheong, the chief dietitian at Changi General Hospital's dietetic and food services. It is no wonder that gout seems to be hitting a younger crowd as they turn to drinking and eating rich food, and shun fresh fruits and vegetables.

Watch your diet

To keep gout at bay, drink plenty of water to dilute the uric acid and avoid alcohol and high-purine animal organs and shellfish. A 2004 American study published in the journal Lancet found that men who drank two or more beers a day were 2.5 times more likely to develop gout than those who did not drink. Another report published in the British Medical Journal in 2008 found that men who consumed two or more sweet soft drinks a day had an 85 per cent higher risk of gout compared with those who drank less than one a month. While controlling your diet is important, doctors may prescribe anti-inflammatory drugs and drugs to control uric acid deposition.

Alternative treatments

There are also alternative treatments for gout, including consuming cherries, coffee or more vitamin C. However, doctors say that those embarking on alternative treatments should do ample research, monitor the effects of such treatments and seek a qualified health professional's advice when in doubt.

Some forms of arthritis can be mistaken for gout and vice versa. For example, in pseudogout – literally false gout – calcium pyrophospate crystals are deposited instead of uric acid, leading to symptoms similar to gout. In this case, trying to lower purine or uric acid levels in the body, or taking uric acid-lowering drugs would not work.

Gout is usually diagnosed by a blood test to measure uric acid levels or an analysis of the joint fluids to detect uric acid crystals. Hence, seeking proper medical help is always important.

Ref: V10

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