Gout: Bane of the Ages

You may not die from an acute gout attack, but the pain can be so intense that any relief from it would be welcome, say two Albuquerque, N.M., rheumatologists.

“These are red-hot swollen joints. An acute attack of gout is extremely painful,” says Mark Cohen, a physician who heads the rheumatology department at Lovelace Sandia in Albequerque, N.M. “The change in air pressure from opening and closing the door can make it worse.”

People have suffered with gout, a form of arthritis, for thousands of years. Even mummies from the tombs of Egypt show signs of the deforming disease, Cohen says.

Gout is caused by uric acid crystals that are deposited in the joints. It usually affects one joint at a time and usually begins with the ball joint of the big toe, according to information from the Arthritis Foundation.

Everyone makes uric acid, a by-product of metabolism. It is usually eliminated through the kidneys. But some people, especially men 40 to 90 years old, either make more uric acid or have difficulty eliminating it. High concentrations in the body can lead to crystal formation and the resulting gout attacks. Untreated, the uric acid crystals can occur in other joints and organs and cause permanent damage, according to arthritis.org.

However, people can have high levels of uric acid, a condition called hyperuricemia, and never have a gout attack or form a certain kind of kidney stone, a related condition of too much uric acid, Cohen says. “Or some have one attack of gout and never have a second,” he says.

Gender Differences

Wilmer Sibbitt, a rheumatologist at the University of New Mexico Health Sciences Center, explains that more men than women get gout, because men usually have greater muscle mass and a higher metabolic rate than women.

Most men naturally have more uric acid than women, but women may develop hyperuricemia after menopause, he adds. People who take diuretics to reduce fluid in their bodies for conditions like high blood pressure can develop high uric acid concentrations. And the higher levels and resulting gout can occur as a result of impaired kidney function or other metabolic diseases like type 2 diabetes.

Less commonly, children can be born with an enzyme deficit and have high uric acid concentrations, Sibbitt says.

Diagnosis can be difficult. Inserting a needle into the painful joint and drawing out the fluid to examine it could reveal the uric acid crystals, but it isn’t “100 percent,” Sibbitt says.

Most diagnoses presume the person has gout, especially if the big toe is involved, Sibbitt says. Doctors look at serum levels of uric acid and symptoms. “If the whole top of the foot or the whole top of the hand is involved, there isn’t a place for the needle (to draw out fluid),” he says. Physicians look to rule out other causes of swollen, painful joints, such as infection, he adds.

But, Sibbitt says, “It can be hard to get to. People think that gout is benign. If it is recurrent, it can lead to degeneration of the affected joint. Delayed diagnosis means advanced gout can lead to osteoarthritis in the knees, toes and feet.”

That means people with long-term gout won’t be able to walk very well or enjoy regular activities of daily life, he says.