Gout with tophus formations in the index and little fingers. Image courtesy of the American Society for Surgery of the Hand.
Gout on a limb
Gout was once called “the disease of kings” or “the rich man’s disease” because it was most commonly associated with excessive consumption of food and alcohol, something that only aristocrats and higher levels of society could afford to indulge.
The English King Henry VIII, for example, famously suffered from gout, as did Isaac Newton and Benjamin Franklin.
Gout is a kind of acute arthritis that occurs when high levels of uric acid in the blood lead to inflammatory crystalline deposits in joints, which become red, tender, hot, swollen and often quite painful and debilitating.
(The image above is a visually extreme example: Monosodium urate crystals have accumulated from repeated attacks of gout in finger joints. Called tophus formations, these accumulations can impair joint function and may break through the skin.)
In recent years, gout has made a comeback of sorts, thanks in part to a Western diet that’s overly rich and abundant. Rates of gout approximately doubled between 1990 and 2010. An estimated 1 to 2 percent of Americans will, at some point in their lives, deal with gout.
Genetics also plays a significant role. A study earlier this year identified 18 new genetic variations that increase uric acid levels in the blood.
While that kind of research presses on, there are plenty of things people can do to avoid gout. Easiest are dietary controls: Gout has a strong association with excessive consumption of alcohol, fructose-sweetened drinks, meat and seafood. Other triggers are physical trauma and surgery.
Gout frequently occurs in combination with other medical problems, such as metabolic syndrome, obesity, hypertension and insulin resistance.
Treatment of gout typically involves temporary measures to ease symptoms of an acute attack and lifestyle changes and medications for long-term therapy. These include non-steroidal anti-inflammatory drugs and compounds like colchicine, pegloticase and allopurinol.