Gout Isn't Gone, Guys

Even perfectly fit men develop the painful condition.

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Gout is a form of arthritis that produces intense bursts of joint pain and affects millions of people—overwhelmingly men. I've always had the impression that the curse was an entirely self-inflicted condition suffered by gluttonous royals of old, but since Gout Awareness Day happens to fall in May, I decided to look more closely at the condition. What I found surprised me. Since two thirds of Americans admit that they know very little about the disease, according to astudy conducted by the Gout and Uric Acid Education Society, it may surprise you, too.

A laundry list of European luminaries suffered from the affliction in the past, but gout is alive and well in today's middle class, and sometimes in people who are otherwise quite fit. HealthDay recently ran a story about Maurice Cheeks, former NBA star and coach, who has gout and hasn't been shy about it (take a look at this YouTube video of Cheeks coaching with one shoe because of gout). And I recently discovered that one of my coworkers is in a similar position; he's thin as can be but has been grappling with gout for the last three years.

I learned a lot about how severe gout can be from talking with him. When the disease struck him, it hit hard. The pain, which centered at first in his big toe, felt like it was caused by broken glass in the joint. Over time, it has crept to his ankles and knees. Sometimes, he can barely walk in the morning, despite the fact that he's otherwise healthy, plays basketball regularly, and is under the age of 50.

"It certainly is an impressive disease," says Brian Mandell, a rheumatologist at Cleveland Clinic. He says that many of his patients find the pain from gout worse than that from broken bones. Elevated uric acid levels in the blood lead to the formation of salt-like crystals in the joints. An attack occurs when the body mounts an immune response against the crystals, attempting to break them down. In some cases, the crystals develop into larger nodules called tophi that lie near the surface of the skin and have a yellowish-white, chalky appearance.

Uric acid levels tend naturally to be higher in men than in women. There appears to be a genetic vulnerability to gout, but making careful dietary choices can help prevent and control the disease. Studies abound linking certain foods rich in organic compounds called purines to an increased risk of gout, since purines raise levels of uric acid in the blood. The bottom line, for men who want to avoid gout, is that they have to be careful about eating too much red meat, seafood, coffee, and beer. One study published in the New England Journal of Medicine in 2004 found that the more red meat men ate, the more likely they were to develop gout. Other studies have shown gout is virtually nonexistent among vegetarians. The Mayo Clinic offers useful dietary tips for people with gout; the Gout and Uric Acid Education Society provides suggestions, too.

There's also evidence that certain foods, especially cherries, can stave off gout attacks. My colleague, in fact, has stopped taking the two types of medications typically prescribed—anti-inflammatory drugs called colchicine and naproxen—because those medications have unpleasant side effects, and he now swears by cherry juice. One study published in 2003 in the Journal of Nutrition clearly shows that consumption of cherries can lower levels of urate, the crystal-forming salt that's derived from uric acid. My colleague says whenever he feels the tingle coming on he'll drink cherry juice and take an Aleve, a regimen that for him has proved as effective at controlling the pain as the meds he used to take.

Mandell acknowledges that cherries can reduce uric acid levels by a "smidgen," but he encourages men with gout to keep in close touch with their physicians, partly because gout significantly increases the risk of cardiovascular problems. It's especially important, he says, that men with gout see their doctors regularly, even though it's often the last thing many men are interested in doing. Untreated gout can lead to bigger joint problems down the line, Mandell says, and remedies like cherries may not be doing as much as people may think. He emphasizes that men with gout should always know their uric acids levels and should aim to keep them below 6.8 milligrams per deciliter.

Doctors should be familiar with the latest treatment innovations and news and are best able to translate the research for patients. Just yesterday, for example, a study appeared in Lancet suggesting that a corticosteroid called prednisolone may be the safest treatment choice for men who have kidney and heart disease along with gout.