By Eduardo Gonzales, MD
What is gout? How prevalent is it in the Philippines? What food should be avoided to prevent it? —firstname.lastname@example.org
Gout is a very painful form of arthritis (inflammation of the joints) that develops when uric acid crystals get deposited in joint tissues. It is characterized by attacks of severe joint pain and swelling, often of the big toe and the foot, but also of the ankle, knee, and sometimes other joints of the body. In general, an attack of gout is confined to a single joint—only occasionally do other joints get involved.
A gout attack usually occurs suddenly, often waking one up in the middle of the night. The affected joint is hot, red, swollen, and so tender that even the weight of the sheet on it may seem intolerable.
Most joint pains are not gout
Filipinos in general are quick to attribute any joint pain or swelling to gout, but gout is a relatively rare form of arthritis. It afflicts only two to four people out of every 10,000. In contrast, osteoarthritis, the most common form of arthritis, afflicts more than 80 percent of people above 55 years old—including those with gout.
Gout is primarily a disease of adult men in their third to sixth decades of life. More than 90 percent of people with gout are men, the disease seldom occurs in premenopausal women and children. Gout is more common in people with a family history of the disease, who are overweight, or eat too much food rich in purines such as steaks, innards (“laman-loob”), seafood, or drink alcoholic beverages especially beer and drinks sweetened with fruit sugar (fructose), coffee and tea, or take medications such as water pills (diuretics) that can trigger gout.
Gout and uric acid
Uric acid is the end product of purine metabolism in the body. Purines are derived either from the food we eat, or from the breakdown of nucleic acids that are naturally produced by the body.
For normal people, excess blood uric acid poses no problem because their kidneys simply excrete the extra uric acid. Some people, however, are unable to properly eliminate uric acid and it accumulates in their blood. Then again, having too much uric acid in blood isn’t necessarily harmful. Many people with high uric acid blood level never get gout because for one reason or another, their extra uric acid does not get deposited in their joints. Thus, blood test for uric acid can be misleading. The definitive test for gout is joint fluid analysis (arthrocentesis) to see whether uric acid crystals are present.
Treatment of gout
Although gout attacks usually subside spontaneously, mild attacks in seven to 10 days, severe ones in several weeks, it is advisable to treat gout not only to shorten the duration of an attack but also to prevent permanent damage to joints and/or development of complications such as kidney stones and tophi—nodules in the skin made up of uric acid crystals.
Gout medications are classified into those that treat an acute attack and those that prevent future attacks and complications of the disease. Drugs used for an acute gouty attack include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen and celecoxib, corticosteroids, and colchicine.
The natural history of gout is recurrence of an attack after a variable period of time, but recurrence can be minimized if one maintains an ideal body weight, drinks at least three liters of water a day, and avoids eating the previously-mentioned purine-rich foods, drinks, and beverages. If, despite adhering to the above-suggested dietary and lifestyle modifications one still experiences acute gouty attacks two or more times a year, one may need drugs that prevent future attacks and complications. These drugs are of two classes: uricosuric agents and xanthine oxidase inhibitors. Uricosuric agents like probenecid promote the excretion of uric acid by the kidneys, while xanthine oxidase inhibitors like allopurinol and febuxostat decrease uric acid production.
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