From Kings To The Average Joe: Gout Makes A Comeback

Jul 28, 2011
Originally published on July 29, 2011 9:45 am

An image of gout is easy to conjure up: The portly, elder royal resting his foot on a pillow, with a swollen, red and extremely painful big toe. It could be Henry VIII, who was afflicted with the "disease of kings."

But today gout seems to be the disease of the average middle-aged American who's pudgy, consuming too much meat and drinking too much alcohol — not unlike what the royals used to do.

Researchers from Boston University School of Medicine looked at federal health surveys to compare rates of gout in 1988-1994 to 2007-2008 and found the disease had increased 44 percent over those two decades. They suspect it has a lot to do with the obesity epidemic and related health problems like diabetes, high blood pressure and high cholesterol. Their study was published online this week in the journal Arthritis & Rheumatism.

Gout is an extremely painful type of arthritis that strikes without warning and causes extreme swelling, inflammation and pain in the joints, mostly in the feet. Too much uric acid is what causes it.

Dr. Hyon Choi, professor of medicine in rheumatology and epidemiology who headed the study, found rates of elevated uric acid levels rising over time. He says one in five Americans have elevated levels of uric acid.

The excess uric acid can cluster and form into crystals, sort of like like sharp microscopic needles. They migrate to joints in the feet, knees, elbows and even shoulders causing intense inflammation and pain, says Choi, that's "excruciating."

There are a number of reasons for too much uric acid. A big one is genetics. Being male also makes you more vulnerable. And the older you are, the greater the risk.

But diet is also a factor. And that is where extra weight and obesity come in. Uric acid is a chemical byproduct of metabolizing high fat and high sugar foods, as well as alcohol.

When Choi closely analyzed the data, he found a strong link between increases in the number of gout cases and the simultaneous rise in obesity and hypertension.

Fortunately, gout is simply and effectively treated with anti-inflammatory medication. And once treated, the best approach by far, says Choi, is to prevent the problem in the first place by eating healthfully and cutting down on alcohol, particularly beer, which can raise uric acid levels.

For more images of gout, you can check out these vintage medical ads, courtesy of NPR's Picture Show blog.

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MICHELE NORRIS, host: From NPR News, this is ALL THINGS CONSIDERED. I'm Michele Norris.

ROBERT SIEGEL, host: And I'm Robert Siegel. Once called the disease of kings, gout conjures images of Victorian England and portly royalty, their swollen feet propped on pillows to ease the pain. Well, a new study finds that gout is making a comeback. As NPR's Patti Neighmond reports, researchers suspect the severe type of arthritis is linked, in part, to the obesity epidemic and diets rich in meats and alcohol.

PATTI NEIGHMOND: It was a sudden onset in the middle of the night. Fifty-one-year-old Greg Hanoush(ph) woke up with a strange sensation in his foot - partly numb, and extremely painful.

GREG HANOUSH: And it was so bad that I had to get my leg out from under the sheets because the pressure of the sheets, on my foot and on my leg, was too much.

NEIGHMOND: He did manage to get back to sleep but in the morning, the pain was worse.

HANOUSH: I couldn't put any weight on the foot. I was hopping around on one foot. It was almost as bad as if the foot was broken.

NEIGHMOND: Hanoush had a similar problem 10 years earlier. He suspected gout, and called his doctor right away.

HANOUSH: He said to get in there, which I did. He confirmed. He did some blood work on me, and confirmed that my uric acid levels were sky-high.

NEIGHMOND: And really high levels of uric acid are the main cause of gout, which was the diagnosis for Hanoush. The excess uric acid had formed crystals, sort of like little needles, and migrated to joints like his feet, elbows and shoulders, causing the intense pain and inflammation. There are a number of reasons for too much uric acid. A big one is genetics. Being male also makes you more vulnerable. So does age; the older you are, the greater the risk. But diet is also a factor, and Hanoush knew his wasn't good.

HANOUSH: I was eating a lot of red meat, and that's one of the worst things you can do for gout. I was also drinking beer. I've been drinking beer as a, you know, regular beer drinker since I was in college.

NEIGHMOND: Meats and alcohol, especially beer, can drive up levels of uric acid, which is a byproduct of digesting these foods. The more you consume, the more uric acid is produced. The same is true for certain seafood like herring and scallops as well as sugar and sugary drinks, like soda. Hanoush's rheumatologist, Dr. Hyon Choi, studies gout at Boston University's School of Medicine, and he was seeing more of it. He wanted to know if nationwide, gout was on the rise. He compared rates of the disease today to about 20 years ago. He found an increase of 44 percent.

Dr. HYON CHOI: This is a substantial increase. The number of individuals affected by gout was 6.1 million in 1988 and 1994. But now, it's 8.3 million.

NEIGHMOND: That's about 4 percent of all Americans. And when Choi analyzed the numbers more closely, he found strong links to simultaneous increases in obesity and hypertension.


Dr. KEITH BACHMAN: Good morning. How are you today?

NEIGHMOND: At Kaiser Permanente's health clinic in Portland, Oregon, internist Keith Bachman sees plenty of patients who are overweight or obese.

BACHMAN: We know as people gain weight, their metabolism changes in lots of ways. And one of those leads to increased uric acid level, which then leads to gout.

NEIGHMOND: In fact, in Choi's story - published in the Journal of the American College of Rheumatology - he says obesity is clearly a factor. Now, one in five Americans has elevated levels of uric acid. Once a patient has gout, another episode is likely, says Choi. The problem is easily treated with anti-inflammatory medication. But Choi says by far, the best treatment is prevention, exactly what his patient Greg Hanoush did.

HANOUSH: I'm going to the Red Sox game tonight, and first thing I'm going to want to do is have a beer while I watch a ball game. It's just, you know, who I am. But unfortunately I'll be drinking water and maybe a glass of wine. And I do miss red meat. I love steaks, hamburgers, all of that kind of stuff.

NEIGHMOND: But it's been worth it, says Hanoush. He hasn't had a recurrence of gout for the past year and a half. And he's lost weight. Patti Neighmond, NPR News. Transcript provided by NPR, Copyright NPR.