Mention gout, and some people conjure visions of Henry VIII hobbling around his castle with a turkey leg in one hand and a goblet of wine in the other. Gout long was considered an affliction of wealth.
Today, however, doctors and patients know it's a serious problem at all income levels, and it's on the increase.
At 52, Sam Cortes has battled gout for more than 10 years.
"It's a devastating disease," said Cortes, who lives in DeBary, north of Orlando. "I lost a career as a Realtor because I would be sick for 12, 15 days at a time and couldn't walk."
A new study by the U.S. National Health and Nutrition Examination Survey estimates that more than 8 million Americans have gout, and that the incidence has increased in the past 20 years, most likely because of rising obesity and high blood pressure. Men are more likely to get it, though women become more vulnerable after menopause.
You may be hearing more about gout these days due to advertisements for new drugs the FDA has approved to treat the condition. But even with these and other medications, it can be tough to manage.
Cortes has been under the care of a specialist in Tampa for several years, but struggles to control flare-ups. "It cost me my career. I'm disabled. I wouldn't wish it on anybody," he said.
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Gout is a form of arthritis that occurs when there's too much uric acid in the blood. The acid crystallizes and forms deposits in the joints, causing painful inflammation, most commonly in the fingers, wrists, knees, elbows and toes.
"The crystals are like having small spikes in the joints," said Dr. Federico Auger, a podiatrist at the Ankle and Foot Center in Carrollwood. He typically sees gout patients during an initial bout, when they don't yet know they have the disease.
The affected joint — often the big toe — suddenly becomes hot to the touch, red, swollen and intensely painful. Why is the big toe affected? Extremities are the coolest parts of the body, and lower temperature is thought to be associated with flare-ups.
"An attack can be so painful that they can't even put a sheet on their foot," Auger said. "It can be red all the way to the ankle."
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Cortes said he didn't understand his condition or get it under better control until he started seeing a rheumatologist. "It made all the difference for me, especially with managing the pain," said Cortes. Now he regularly makes the two-hour drive from his home to see Tampa rheumatologist Edgard Janer.
Treatment of gout includes using anti-inflammatory medications like ibuprofen or naproxen, oral and injected steroids, and drugs to reduce uric acid levels in the blood. Sometimes the joints can become so inflamed that it's necessary to drain the excess fluid.
Patients must also get other chronic conditions like diabetes, high blood pressure and obesity under control, and follow certain dietary guidelines (see box). Janer said managing chronic gout depends on the patient's willingness to make lifestyle changes.
"First is acceptance of what you have," he said. "Don't ignore the problem. Don't keep gaining weight, eating the wrong foods, drinking alcohol, not controlling diabetes and blood pressure. Then it becomes a perpetual cycle."
Untreated gout is not only painful, it also can lead to permanent joint damage.
Cortes used to eat a lot of beef and enjoyed a couple of beers on the weekends, but now he avoids alcohol and eats primarily salads, fresh fruit, rice and certain fish and nuts for protein. He has lost more than 35 pounds in the past couple of years. At 6 feet tall and 235 pounds, he has more to lose, but the changes he has made have meant fewer and less painful gout attacks.
"The teaching that I got from Dr. Janer was so helpful. I didn't even know what gout was. He taught me how to eat and what to do," Cortes said. "I'm so happy to know that I can feel a little bit better."
Irene Maher can be reached at firstname.lastname@example.org.