Gout: A New Perspective On an Old Disease

Remarkable progress has been made in diagnosing gout

By Barbara Pierce

Suddenly, one morning, my elbow hurt when I moved it. “I must have slept on it wrong,” I thought. But it didn’t go away. It kept getting worse.

“Must be arthritis,” I thought. As a 52-year-old woman, I hadn’t been bothered by arthritis yet. Movement helps arthritis, so I began moving my arms wildly. The pain only got worse.

Over-the-counter painkillers didn’t touch my pain. The slightest movement of my arm became unbearable. I had to hold it perfectly still to be tolerable.

Wide awake and in excruciating pain during the night, I cried. I’m not a crier.

I went to the emergency room. They took X-rays and gave me strong pain killers. They were puzzled, couldn’t come up with a diagnosis.

Gout was ruled out — it hit older men; it didn’t attack elbows.

It was gout. (That was many years ago.)

Gout is an underappreciated and extremely painful condition, one of the oldest afflictions. With severely intense pain, it can greatly impact your quality of life.

It’s what you get when your body has too much uric acid. Uric acid is a natural compound in your body, excreted through urine. However, if you have too much of it, it forms tiny, spike-shaped crystals that get into your bloodstream and find their way into your joints, causing a gout attack.

We asked physician Martin Morell of Arthritis Specialists in New Hartford for more information.

“It really hurts,” said Morell. “The pain subsides in three or four days. Once you have it, there’s a high chance you’ll get it again.”

“It’s becoming more common — because we’re becoming more aware of it through early diagnosis,” said Morell.

Remarkable progress has been made in diagnosing gout since I had it.

Diagnosing includes an examination, family history, lab work, imaging tests, including X-rays. It can be diagnosed only during a flare-up when a joint is hot, swollen, and painful and when the lab finds uric acid crystals in the affected joint (the same crystals that cause kidney stones).

In determining if you have gout, the health care professional asks about your eating and alcohol consumption habits. These questions identify any lifestyle-related risk factors for gout, such as sugar consumption and heavy alcohol drinking.

More than half of the cases of acute gout occur in the big toe for the first time. And men are more often victims. “Estrogen protects women, until menopause,” Morell explained.

“The cause is associated with genetics,” said Morell. The main risk factor for developing gout is high uric acid. 25% of people with a uric acid level more than 7.0 will develop gout.”

“Most lab work doesn’t include your uric acid levels unless you’re at risk,” continued Morell. “This is an important level that should be checked.”

It’s important to know if your uric acid level is high because, left untreated, it not only causes gout and kidney stones, it destroys joints and causes kidney damage and is associated with high blood pressure, high cholesterol, diabetes, heart disease, even dementia, say some.

“It will shorten your life,” Morell cautioned.

Treatment of acute gout includes anti-inflammatory drugs and/or steroids, said Morell.

Luckily, those painful gout attacks are very treatable and manageable if you get a proper diagnosis and start treatment promptly. This will include medications to control inflammation and lower your levels of uric acid, along with a few lifestyle changes to prevent future attacks.

If your uric acid level continues to stay too high, more and more crystals form around your joints, and can land in your kidneys, vertebrate, heart valves, even your eyes, he continued.

You’ll have chronic gout, repeated episodes of pain and inflammation. If you have it for years, the large yellow clumps can land anywhere in your body.

High levels of uric acid must be treated or will to lead to permanent bone, joint and tissue damage.

For most people, medication along with changes in diet are needed to lower uric acid levels and prevent gout — avoiding alcohol, soft drinks, shellfish, red meat, and sugar heavy foods or beverages.

As for me, I had no more gout attacks for 20 years. However, during that time, I had a stroke and was diagnosed with diabetes, heart disease and kidney disease. Because of these diseases, I had modified my lifestyle and avoided red meat, alcohol, soda and limited my sugar intake, which is perhaps why I had no episodes.

Some believe that gout and high uric levels are associated with metabolic syndrome, a cluster of conditions that occur together — increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride level and may increase your risk of stroke, heart attack, diabetes, even dementia. I have metabolic syndrome. Could be a connection.

Recently, I began having gout attacks in my knees. It was quickly diagnosed and I got an injection. Now I’m on a daily medication which lowers my uric acid; guess I’ll be taking it forever.