A Look At Gout

More and more people are coming to doctors with symptoms of gout. Gout is generally thought of as a disease of the Victorian upper class. There is some truth to this, in that it was common among the upper class and nobility in and before the Victorian era, to the point where it was once known as the "disease of kings." However, gout is still around, and it’s not just the rich. That’s because gout is in part a disease of diet and lifestyle, and both of these things are more democratic than they were in centuries past; ordinary people in 2014 are leading lives unimaginable to even the nobility 100 years ago.

In particular, people today consume more alcohol, seafood, red meat, and other foods containing compounds called purines. Purine contributes to a buildup of uric acid, which, as the name suggests, is ordinarily passed in urine. However, when people eat a purine-heavy diet, they are more prone to overwhelming their kidneys with uric acid, to the point that the kidneys are unable to get rid of all of it. When this excess uric acid builds up in the joints, they become painful and inflamed. Gout is most common in men and in postmenopausal women.

The most common symptom is painful joint swelling in the feet, especially the big toe. The swelling is accompanied by redness and tenderness. This pain is intense for 12 to 24 hours and gradually lessens, though it can last for weeks. Subsequent gout attacks may have a slightly lower peak, but they last longer and the pain is in more joints. Even when people exhibit these symptoms, gout is often underdiagnosed because people&mash;even doctors, sometimes&mash;associate it with rich people of an earlier era, and may not think to look for it.

In addition, the standard diagnostic technique is not always precise. When someone is showing symptoms of gout, the doctor will take a sample of joint fluid and examine it to look for the characteristic uric acid crystals, but doctors don’t always find these. Now a new study used computerized tomography (CT) scanning to look for signs of gout that the usual approach might miss. One in three patients who tested negative under the microscope showed indications of gout in the scanner, allowing them to get the treatment they needed.

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