Feingold: Gout: No longer a disease of the wealthy

What do the following people have in common: King Henry VIII, Leonardo da Vinci, Luciano Pavarotti and Benjamin Franklin?

The answer is, they all had gout. And, note, most of them were overweight.

Gout was once called a disease of the wealthy, and the main reason was, in the old days, only the wealthy were able to afford to eat the foods associated with this condition.

However, today, most people are able to purchase gout-associated foods, such as meat and seafood, or, drink a lot of alcohol. As a result, gout has become a much more common condition affecting about four percent of the population.

During the past 30 years, the incidence of gout has almost doubled. Some reasons for this are people are living longer, an increase in obesity and more individuals eating an inappropriate diet.

Another factor is an increasing number of people are taking medications that are associated with gout. For example, diuretics increase the amount of uric acid in the body. There are some misconceptions concerning uric acid and gout. First of all, the majority of people with increased uric acid do not develop gout.

Secondly, not everyone with gout has a high uric acid. Why is it that some people who eat a lot of meat and seafood, drink alcohol and are overweight do not develop gout? Recent studies show that in some patients, genetics plays a role. In fact, a gene has been found that is associated with certain cases of gout.

Symptoms of acute gout usually consist of pain in just one joint or the soft tissue surrounding the joint, frequently the large toe, the mid-foot or ankle. The diagnosis can be confirmed by a needle aspiration of the fluid present in the involved joint, looking for certain crystals.

However, usually the diagnosis can be made just by history and physical examination. Joint aspiration may be necessary when the diagnosis is not certain or there is concern that the joint is infected or septic, thus requiring antibiotic treatment.

In chronic gout, more than one joint may be involved.

Acute episodes of gout are usually treated with non-steroidal anti-inflammatory drugs such as indomethacin. Other drugs used include colchicine and corticosteroids.

The disease may be prevented by taking preventative measures such as avoiding the various factors associated with gout.

Dr. Murray Feingold is the physician in chief of The Feingold Center for Children, medical editor of WBZ-TV and WBZ radio, and president of the Genesis Fund. The Genesis Fund is a nonprofit organization that funds the care of children born with birth defects, mental retardation and genetic diseases.