The Rich Man's Disease

View PDF

Since Hippocrates' day, gout has been linked to high living

Benoit Legault

Keep moving

Gout. A strange name for a strange disease. It conjures up a slightly comical image of an older, well-heeled man — perhaps in a fur-trimmed dressing gown — with a red nose and a painfully swollen foot bandaged and resting on a footstool. Called, colloquially, king’s foot and the beer drinker’s disease, gout is actually a form of arthritis. It’s one of the most painful conditions — and one of the most oddly named.

It comes from the Latin word for a drop of liquid, gutta, but is actually triggered by solids: tiny needles of crystallized uric acid that are deposited in joints and ligaments, particularly in the big toes, but also in the hips, hands and knees. These cause redness, swelling and intense pain and can form a stone called a tophus. Uric acid is a  waste product formed by the breakdown of basic compounds in cells and foods called purines. Normally, this acid is eliminated in the urine.

eorge Faulkner can attest to the painful reality of this inflammatory condition. “The pain was so intense that it woke me up at night,” says the 51-year-old resident of Marieville, Que. “I couldn’t figure out what was wrong with my big toe. I thought I had dislocated or sprained it — or possibly even fractured it.”

Although he experienced just one bout of gout, George is a likely candidate for being on the receiving end of its nasty effects. George is overweight and a regular beer drinker. He consumes lots of carbonated soft drinks and quite a bit of red meat as well — all risk factors. Furthermore, as a male over age 40, he belongs to the group that is most susceptible to this disease, which affects about 1% of the world’s population and up to 500,000 Canadians. Women are less likely to get gout, possibly because the female hormone estrogen aids in the excretion of uric acid.

Gout was named at the turn of the 13th century, when, according to the ancient doctrine of humours, it was believed that tainted drops of humours became lodged in the joints. In a sense, that theory was not far from the truth because gout is caused by an excess of uric acid circulating in the blood. In addition, says Dr. Emile Elfassi, a general practitioner at the MediMax Clinic in Montreal, “other diseases can lead to gout — psoriasis, arthritis, certain lymphomas and metastatic cancer, for example.”

Foods that are high in uric acid-forming purines promote gout in susceptible people. These foods include red, game and organ meats, dark-fleshed poultry such as duck and goose, shellfish, and dark-coloured fish such as salmon, sardines and anchovies. Certain high- and moderate-purine legumes and vegetables are linked to gout — dried beans and peas, asparagus, cauliflower, mushrooms, Brussels sprouts and spinach, for example. Some research, however, suggests that vegetable and dairy purines have little or no effect on gout. 

When hyperuricemia goes untreated, the buildup of crystallized uric acid increases. These crystals eventually destroy the cartilage and bone in the joints, causing pain with every movement. When they form a tophus, they may break through the skin in a chalky nodule. The crystals can cause pain and stones in the kidneys, where they set the stage for eventual renal failure. They can also lead to painful blockages and spasms in the lower urinary tract.

The main treatment for gout is non-steroidal anti-inflammatory drugs such as indomethacin and ibuprofen to relieve pain. Drinking plenty of water reduces uric acid levels in the blood, and applying ice to the affected joints for 30 minutes four times a day eases pain and reduces swelling.

“If these  initial treatments don’t work, an infusion of cortisone may be indicated,” says Elfassi. In chronic gout, a drug called allopurinol is given to reduce uric acid production. Other drugs accelerate excretion. Patients are advised to avoid alcohol and carbonated drinks and reduce their intake of red meat.

And if expensive food and drink cause gout, expensive food may relieve it. Sour cherries, for example, may cost $5 a pound, but with their high content of anti-inflammatory pigments called anthocyanins, they can help ease those swollen joints. “In fact, consuming all types of fruit seems to benefit,” says Elfassi. For more on gout, visit the website of the Arthritis Society at www.arthritis.ca.