Gout is probably one of the most over-romanticized human ailments.
Literary giants of the Victorian and Edwardian age, including Charles Dickens, Anthony Trollope, Horace Walpole and George Eliot (Mary Anne Evans), all treated gout with what can only be called an unusual reverence.
Today even the National Institutes of Health admits “the merits of gout have been extolled over the centuries by physicians and laypersons,” and as NIH points out, “gout was regarded as a badge of nobility, a talisman against other afflictions and an aphrodisiac.”
Horace Walpole, the 4th earl of Oxford, went so far as to claim gout “prevents other illness and prolongs life.”
That’s wildly misguided praise for what we now know is actually a form of arthritis, which is broadly defined as joint inflammation.
Dr. Julio Pagan with the Cleveland Clinic Indian River Hospital’s Oslo Road location agreed to talk about the modern view of gout.
Asked when gout ceased being thought of as a malady of the wealthy, Pagan smiles and says, “I guess when the general population partook of the exorbitant lifestyle” once enjoyed mainly by the well-to-do, including, he says, a diet “rich in meat” and well lubricated with alcohol.
Pagan’s point is backed up by the U.S. Department of Agriculture and Forbes Magazine.
In 2018, says the USDA, Americans ate more red meat and poultry than ever before: an average of 222.2 pounds per person, which was up from 216.9 pounds in 2017. In 1818 or 1918 the vast majority of the country’s population consumed far less meat.
At the same time, Forbes reports 73 percent of the American adult population consumes at least some alcohol.
So what, exactly, causes gout? Uric acid, according to the Mayo Clinic.
It says, “Your body produces uric acid when it breaks down purines which are substances that are found naturally in your body,” but adds “purines are also found in certain foods, such as steak, organ meats and seafood. Other foods also promote higher levels of uric acid, such as alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose).
“Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes either your body produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needle-like urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.”
That’s gout – which Pagan says has “a genetic component to it” as well. You may be pre-disposed to gout based on your genes. “Gout has become more common in the United States in the past two decades, in part because of the nation’s obesity crisis and a greater frequency of high blood pressure, new research indicates,” according to WebMD.com. “The condition now affects about 8.3 million people, or 4 percent of the population. And the risk of getting gout increases with age.”
The good news is that gout “is a very treatable disorder,” according to Pagan. “It’s usually fairly easy to pick up on and can be prevented with minor limitations to diet [and] with medication.”
Those medications could include Colchicine, Indomethacin, Proboscidean and assorted anti-inflammatories, though Pagan adds “we also use vitamin C as a ‘poor mans’ Proboscidean, which does much of the same thing.”
There is, however, a serious caveat to the treatability of gout: What might seem to be gout could be cancer.
“If an adult suddenly develops gout and they don’t have the typical risk factors – they are not a heavy meat eater and don’t imbibe in a lot of alcohol – as a doctor, you have to think of that as [potentially] a tumorous process. [In that case] it’s important to at least get a complete blood count and look for other evidence of other types of tumors.”
A veteran internal medicine and adult medicine specialist from Brooklyn, N.Y., by way of St. Petersburg, Fla., Pagan cautions that ignoring an attack of gout may only make matters worse.
Even if cancer is not detected, those who can withstand the sudden, severe attacks of pain, swelling, redness and tenderness in the joints – most often the joint at the base of the big toe – may be setting themselves up for even more pain in the future as the condition spreads, because, Pagan says, “arthritis can develop in other joints down the road.”
Aside from genetics and diet, other contributing factors in gout can include obesity, high blood pressure, diabetes, metabolic syndrome as well as heart and kidney diseases. Even having had a recent surgery has been associated with an increased risk of experiencing a gout attack.
So, if you’ve got gout – or think you might – brush off those Victorian- and Edwardian-era misconceptions and go see your primary care physician.
Dr. Julio Pagan is with Cleveland Clinic Indian River Hospital. He works from the hospital’s satellite branch at 4165 9th Street SW (off Oslo Road), Suite 106. The phone number is 772-569-7706.