Gout is described as the most painful arthritic condition, and yet it’s nicknamed the “disease of kings.”
That’s because it was historically understood as only caused by diet and lifestyle, and the food that caused it was only accessible to the very rich and royalty.
But anyone can get gout, and it’s now hitting more people than ever, doubling in the past two to three decades.
It’s a chronic condition that, if untreated, can permanently damage the body.
“Gout is a type of a joint disease or arthritis that is caused by deposition of uric acid in the joints,” said Dr. Pankaj Bansal, a rheumatologist at Orlando Arthritis & Rheumatology Clinic.
Uric acid is the outcome of purine, the structural foundation of DNA and RNA breakdown. It’s usually excreted through the kidneys.
“But for various reasons, if somebody starts building up uric acid and they have higher uric acid, then the blood gets saturated,” Bansal explained. “Once the blood gets saturated, the uric acid starts depositing in the joints where it can cause acute arthritic episodes, which we call gout.”
And gout can be extremely painful.
“Imagine as if somebody took a hammer and hit your toe with the hammer,” Bansal said.
One big misconception is that you don’t have to treat it.
“It is a chronic condition, and if left untreated, gout can cause permanent destruction of the joints,” Bansal said.
Another misconception is that gout is only caused by diet. One-third of purine comes from foods like seafood, red meat, and alcohol, not plants, and the other two-thirds are from daily cell breakdown.
“It is not the intake of uric acid that causes high uric acid and gout. It is the inability to excrete uric acid that causes more gout,” Bansal said.
There are two gout treatments: First is acute attack management, which is to treat a pain flare from gout with anti-inflammatory medications, ranging from ibuprofen to steroid injections in the joints.
Second is bringing down uric acid levels with medications like pegloticase, allopurinol, febuxostat, and probenecid. But right now, there is no cure.
“We can treat gout, we can prevent gout, but there is no cure for gout,” Bansal said.
Other ways to help manage gout include being physically active and avoiding foods and drinks high in purines, like red meats, sugary drinks and foods, alcohol, and certain seafoods, such as mussels, scallops, tuna, trout, sardines, and anchovies.
Other risk factors for gout include obesity, diabetes, high blood pressure, and kidney disease.
Also, men are three to four times more likely than women to get gout as they grow older. One of the big reasons why gout is more prevalent in men than women is estrogen, which helps women get rid of uric acid. After menopause, the risk of gout goes up in women but is still half as likely as in men.