You probably thought that gout went the way of the much-married British monarch Henry XIII and it had died out, but in fact the opposite is true: more and more Australians are being diagnosed with the condition we often associate with enjoying far too much of the good life.
While historical records suggest the UK royal did indeed have gout, probably as a result of over indulging in offal, seafood, alcohol and red meat, the illness’s reach in the 21st century has changed.
Today, the most common age group to be afflicted by gout is men in their 20s, though anyone at any age can be diagnosed with it. Hereditary factors often play a significant role in being diagnosed.
So what exactly is gout? It’s a serious illness that’s not curable, where crystal deposits of uric acid accumulate in the body, specifically the joints and tissues, which triggers an immune response. Humans are the only animals who don’t have the enzyme – uricase – to process and break down uric acid.
But even taking into account hereditary considerations, gout is increasingly being described by doctors as a lifestyle disease because our modern diets rely more on processed foods, particularly those high in fructose corn syrup such as baked goods, cereals and soft drinks.
Drinking lots of alcohol on a regular basis is no friend of gout either, says rheumatologist Dr Maxine Szramka who looks after patients with mostly severe cases of gout at the Rheumatology Centre.
One of the newer “culprits” linked to gout – fructose – needs to be kept in check in our diets, says Dr Sramka. One of the first questions asked of a person susceptible to gout is how much sugar is in their diet – in whatever form.
If you suspect you have gout, you need to have tests to confirm the diagnosis. It’s not uncommon for it to be confused with rheumatoid arthritis as symptoms may be similar.
Avoid sugary foods high in fructose to minimise the risk of developing gout
“What we’ve found is that high levels of uric acid are often associated with what we call ‘The Metabolic Syndrome’. That is, there are links to conditions such as obesity, hypertension and diabetes,” says Dr Szramka. As a result, gout can cause long periods off work, physical impairment, and negative economic consequences for the individual and the community.
Dr Szramka says gout numbers have been on the rise in Australia since the 1970s – recent figures suggest about 1.5 per cent of the Australian population has gout; in the US the figure is now 3 per cent, which she says is high.
Dr Szramka says the number of Australian men aged 50+ with gout is on the rise as well as post-menopausal women, which is often triggered by hormonal changes.
“Most of my patients tend to be overweight or heavy set, that is generally associated with gout, and while they say they will make lifestyle changes such as modify their diet and do more exercise to try and deal with the condition, many of them don’t,” she says.
“Although it can impact any joint, it often first appears in the big toe, where the joint is swollen and the whole area is shiny and red,” says Dr Szramka.
“On a pain level, an acute attack of gout can be 20 out of 10, it can be absolutely excruciating,” she adds. “People often say they can’t bear to have anything on them when gout flares up, not even a sheet. Walking can be extremely difficult.
“It can be treated with medications that lower the levels of uric acid in the body, known as preventers, but it’s certainly true that lifestyle modifications such as long-term changes in diet, losing weight and exercising regularly can help reduce the number of episodes a person has,” she explains. Drinking plenty of water on a regular basis daily is one of the best ways to flush uric acid out of your body.
She says someone with gout needs to be aware that certain foods which can act as a trigger for a flare up. These triggers vary from individual to individual, but can include shellfish, alcohol, red meat or seafood. A flare-up can last anything from 24 hours and can be dealt with anti-inflammatories, but a more severe attack can last weeks or months.
Generally speaking, a few mild episodes of gout per year can be treated by your GP but more intense regular episodes need to be managed by a specialist as treating gout can be quite complicated and need specialist knowledge.
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