December 16, 2012
Of late, many medical journals are abuzz with articles & studies focusing on suboptimal care of & the negative perceptions of gout (among patients as well as health care providers).
In fact, Annals of Rheumatic diseases, a reputed rheumatolgy journal, has published a review ‘gout: why is this curable disease so seldom cured?’
1) Gout is now the most common inflammatory arthritis & is in fact more common than Rheumatoid arthritis. The increasing incidence has been blamed on increasing life expectancy, lifestyle factors & use of medicines especially diuretics.
2) Gout is often looked at as an episodic ailment causing short term discomfort. However it is a chronic disease & failure to understand this results in recurrent episodes.
3) Urate lowering therapy (Allopurinol, Febuxostat) can trigger a fresh attack of gout. This should not be considered as a failure of therapy.
4) Urate lowering therapy is not started during an acute attack.
5) The bigger picture of gout is often forgotten. Gout is associated with hypertension, metabolic syndrome. Hyperuricemia & gout are independent risk factors for cardiac & kidney ailments. Due consideration of the bigger picture is required from the medical professionals.
6) Once Urate lowering therapy is started, regular followup is a must even in the absence of fresh attacks. Treatment is titrated to achieve a serum Uric acid level less than 6 mg/ dl.
Gout: why is this curable disease so seldom cured? Doherty M et al Ann Rheum Dis 2012;71:11 1765-1770
Patient and provider barriers to effective management of gout in general practice: a qualitative study. Spencer K et al Ann Rheum Dis 2012;71:1490-1495
April 22, 2012
Gout is a painful arthritis associated with high levels of uric acid in the body.
Uric acid is a product of break down of the purines in the body. Being a breakdown product, it is naturally present in blood. However, when it accumulates in the blood in excessive amounts (known as hyperuricemia), it has a tendency to precipitate in the joints. Once out of the blood, body’s immunity recognizes it as a foreign material and attacks it. This leads to inflammation in the joints causing the redness and severe pain of gout.
Gout has been called the disease of kings and is commonly associated with over-indulgence, fine wines and good living. Man has known the relationship between gout & diet since centuries. “When a few glasses of wine, ale, or porter, quickly and invariably produce….an inflammatory affection of a joint, such inflammation is of a truly gouty character” – was something written down in 1876.
Here is a list of 7 culprit foods to avoid if you have Gout–
1. Alcohol – a major culprit in causation of hyperuricemia & gout.
Alcohol increases the urate production in the body & also interferes with its excretion in urine. Alcoholic beverages also contain some amount of purine that gets converted to uric acid in the body. Beer, among the alcoholic beverages, has higher purine content & is more likely to cause hyperuricemia & gout. Standard beers have an alcohol content of about 1 gram per 100 mL & contain about 8 mg purines per 100 mL. Both the alcohol & the purine would add to the uric acid in the body.
Choi Hk & colleagues studied 47,150 men with no history of gout over a period of 12 years. 730 men developed gout over this period of time. Compared to those who don’t drink, alcohol was found to increase the risk of gout & the same was found to increase with the amount consumed daily. Compared with men who did not drink alcohol, the relative risk of gout was 1.32 for alcohol consumption 10.0-14.9 g/day, 1.49 for 15.0-29.9 g/day, 1.96 for 30.0-49.9 g/day, and 2.53 for > or =50 g/day. wine consumption was not associated with an increased risk of gout.
2. Meat/ poultry/ fish – Animal proteins are high in purine content. Body breaks down these purines into uric acid. Have a look at this link for the purine content of different dietary items.
3. Asparagus, cauliflower, spinach, and mushrooms are higher in purines than other vegetables.
4. Organ meats, such as liver, kidneys, and sweetbdreas.
5. Turkey and goose are higher in purines than other types of food.
6. Shellfish such as crab and lobster.
7. Beverages sweetened with high-fructose corn syrup.