To stay safe from this debilitating and painful disease, keep away from too much alcohol and red meat, advises DR BRIGID MONDA
Gout has been called the disease of kings because it is considered an ailment of the well-to-do.
It is one of the oldest medical diagnosis known and was first described by the ancient Greeks. Its name derives from the Greek word ‘gutta’ for drop because they thought that ‘bad humours’ were dropping into the joints from the body, causing gout. Gout is a form of arthritis, which is an inflammation of a joint’
What causes gout?
Uric acid is the culprit. It is the final break down product of amino acids called purines found in many foods, particularly red meat, liver and kidney and certain types of fish like sardines.
Uric acid in normal amounts remains dissolved in the blood, and is excreted by the kidneys as waste. Gouty arthritis develops when there is a higher than normal level of uric acid in the body and these forms crystals, particularly in the joints and tendons.
The body’s immune system recognises them as invaders and the white blood cells attack them, releasing chemicals which cause the severe irritation, inflammation, pain and swelling characteristic of gout.
Who gets gout?
About 95 per cent occurs in men. It is rare in women before menopause because women have lower uric acid levels than men do and the female sex hormones are protective until after menopause. Men are more likely to develop gout between the ages of 30 and 50, while women, if at all, develop itbetween the ages of 50 and 70 after menopause. Certain medications for the treatment of cancer can cause gout in younger women or if they have certain genetic disorders.
What factors are associated with gout?
Those at risk are those who can afford a continuous supply of alcohol, and maintain a diet high in animal protein like nyama choma. Gout is also more common in the urban populations. Gout is also associated with obesity as heavier people have higher uric acid levels, excess alcohol consumption especially beer, high blood pressure, high blood cholesterol levels, diabetes and kidney disease.
How does alcohol cause gout?
Most types of alcoholic beverages like beer do not contain purines, but alcohol interferes with the kidneys’ excretion of uric acid. It also stimulates the kidneys to produce a lot of urine, causing dehydration and increasing the concentration of the uric acid in the body and joint fluids. Red wine does contain purines.
Why does gout affect the joints of the feet?
Joints contain synovial fluid, which acts as a lubricant for the joints to move smoothly over each other.
Uric acid dissolves poorly in synovial fluid so it crystallises in the joint tissues just as salt forms when salty water cools. This is why the feet are the first site of the initial attacks because they are cooler than other parts of the body.
The ankles, knees wrists elbows and small joints of the hands may also be affected.
What are the symptoms of gout?
An acute attack of gout is painful. The pain is usually sudden and explosive often waking the man up at night. The big toe feels as if it’s on fire and is hot, swollen and so tender that the weight of a sheet on it is unbearable. The skin is shiny with dilated veins and there may be fever.
What triggers the attacks?
Dietary excess especially of meat, injury to the joint, dehydration, excessive alcohol ingestion and sudden severe illness. Certain drugs like diuretics which cause kidneys to produce a lot of urine can also trigger an attack.
What are the long-term effects of gout?
Chronic gout is crippling, with cartilage and bone destruction, joint deformities and collection of uric acid crystals called tophi in the joints making the condition worse. Damaged kidneys as kidney stones may form, especially in hot climates. At the worst, it may result in kidney failure.
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