Gout—Causes and Risk Factors
GOUT is one of the most common forms of arthritis and can be extremely painful. “Gout is a disorder of the metabolism of uric acid,” says the book Arthritis. What is more, it “is a disorder with a clearly identified cause—the presence of uric acid crystals in the synovial fluid of a joint . . . , particularly in the big toe.”
Uric acid is a waste product circulating in the blood, and it results from the breakdown of substances called purines. When uric acid builds up, usually from insufficient elimination in urine, needlelike crystals can form in the joint at the base of the toe, although it may strike other joints. The joint may become inflamed and swollen, hot to the touch, and excruciatingly painful.* “Even just a slight touch causes an unbearable stabbing pain,” says a sufferer named Alfred.
“Without treatment, a gout attack usually lasts about one week,” states an information sheet published by Arthritis Australia. “Another attack may not happen for months or even years. If gout is not managed well, the time between attacks may get shorter, the attacks [may become] more severe and the joints can be permanently damaged. Sometimes gout can progress into a chronic (long term) condition.”
Gout is one of the most treatable forms of arthritis. The treatment usually focuses on nonsteroidal, anti-inflammatory drugs or, in recurrent or very severe attacks, on allopurinol, which helps to prevent the formation of uric acid. Can recurrence of gout be prevented? Possibly, if the sufferer is aware of the risk factors.
Risk Factors for Recurrence
The primary risk factors are age, gender, and genetics. According to some authorities, more than 50 percent of sufferers have a family history of the disease. “Both my father and my grandfather had gout,” says Alfred, quoted earlier. Moreover, gout mainly affects men, targeting especially those between the ages of 40 and 50. In fact, men are three or four times more likely to get the disease than women, who rarely develop it before menopause.
Obesity and diet: The Encyclopedia of Human Nutrition states: “Dietary management of gout no longer seems to be focused on restriction of foods with a high purine content but, rather, on the treatment of metabolic disorders commonly associated with gout: obesity, insulin resistance syndrome, and dyslipidemia,” or abnormal blood levels of lipids, such as cholesterol.
Nevertheless, some authorities also recommend cutting back on foods that contain high amounts of purines, such as yeast, certain fish, and various red meats.*
Drink: Excess alcohol consumption can inhibit the excretion of uric acid, causing a buildup.
Medical conditions: According to the Mayo Clinic, in the United States, gout may be triggered by certain medical conditions, including “untreated high blood pressure (hypertension) and chronic conditions such as diabetes, high levels of fat and cholesterol in the blood (hyperlipidemia), and narrowing of the arteries (arteriosclerosis).” Gout is also linked to “sudden or severe illness or injury, and immobility due to bed rest,” as well as kidney disease. Evidently, the big toe is a prime target of gout because of its poorer circulation and lower temperature—two conditions that can promote the buildup of uric acid.
Medications: Products that increase the risk of gout include thiazide diuretics (drugs that promote the release of water from the body, commonly used to treat high blood pressure), low-dose aspirin, antirejection drugs given to transplant patients, and chemotherapy drugs.
Five Keys to Reducing the Risk of Recurrence
Because gout attacks have been linked to lifestyle factors, the following suggestions may help sufferers reduce their risk of further attacks.*
1. Because gout is a metabolic disorder, sufferers should strive to maintain a healthy weight by limiting their calorie intake. Moreover, excess weight adds stress to weight-bearing joints.
2. Beware of crash diets and rapid weight loss, which may temporarily elevate uric acid levels in the blood.
3. Avoid excessive amounts of animal protein. Some recommend a limit of six ounces (170 grams) of lean meat, including poultry and fish, a day.
4. If you drink alcoholic beverages, do so in moderation. If you have a gout attack, it may be wise to avoid alcohol altogether.
5. Drink plenty of nonalcoholic liquids. These help dilute uric acid and flush it out of the body.*
The preventative measures above may remind us of the Biblical injunction that we be “moderate in habits” and not given to “a lot of wine.” (1 Timothy 3:2, 8, 11) To be sure, our loving Creator knows what is best for us.
Similar symptoms may occur when calcium pyrophosphate crystals form in the joints, in particular the smooth cartilage lining the ends of bones. However, this “pseudogout” is a different ailment and may require different treatment.
According to an article published in Australian Doctor, the consumption of purine-rich mushrooms and vegetables, such as beans, lentils, peas, spinach, and cauliflower, “has not been shown to be associated with a similar increased risk of acute gout.”
This article is not intended to be a medical guide. Each sufferer may require personalized medical management. Also, he should not stop taking prescribed medications or make major dietary changes without first consulting his doctor.
This information is based on recommendations provided by the Mayo Foundation for Medical Education and Research.
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Accumulated uric acid crystals