SHABIHA NUR KHATOON
Although daily intake of purine-rich foods triggers hyperuricemia, a condition in which uric acid levels in the bloodstream increase and the acid crystals get accumulated around the joints leading to severe pain and inflammation, doctors believe climate and lifestyle too play a part in aggravating the ailment
Intemperate habits and an indisciplined lifestyle may be the cause of many painful and dangerous ailments, as Delhi-based Satyam (name changed), aged 65, realised very late in life. Satyam who had a long history of gout is afflicted so badly at times that he is not able to pull a sheet up over his legs. The “the rich man’s disease”, as gout is often called, was thought to be caused by a diet rich in meat.
Gout is a painful condition that occurs when the bodily waste product, uric acid, is deposited as needle-like crystals in the joints and soft tissues. In the joints, these uric acid crystals cause inflammatory arthritis, which in turn leads to intermittent swelling, redness, generation of heat, pain, and stiffness in the joints.
“After several nights of eating out with friends, I woke up with my foot on fire one morning. My toe and the whole side part of my foot were swollen and had turned red. I couldn’t even get out of bed,” Satyam recalls.
“When I get gout, it keeps me off my feet for about a week,” says Satyam who has limited his dietary intake and eliminated alcohol. “Ever since my first attack, I have avoided taking high fibre food and things seem to be in control. I have been pretty lucky, as proper diet has kept the gout attack at bay for a long time,” adds Satyam.
Sunday POST speaks to orthopaedic specialists about uric acid attacks and how they could be best controlled.
Dr Arvind G Kulkarni, Head of Mumbai Spine Scoliosis & Disc Replacement Centre, Bombay Hospital, says gout is today the most common inflammatory arthritis in men and older women. This excruciatingly painful condition is caused by the crystallisation of uric acid in the joints.
Arvind says that the uric acid level in blood increases when the kidneys can’t eliminate it efficiently. It is produced by the body due to natural breakdown of cells and from the food we eat. Most of the uric acid is filtered out by the kidney and passes out through urine, but when too much of it is produced, the kidneys may fail to eliminate it all. This leads to increased levels in the bloodstream. High levels cause solid crystal formation in the joints leading to the painful condition called gout.
Climate too plays a vital role, points out the Mumbai-based orthopaedic specialist. “During summer, the hot and humid climate leads to dehydration and increases the risk of attack. Due to sweating the body fluids drain out leading to recurrent attacks. When after sometime the body gets accustomed to the climatic consistency, pain may subside. Sudden drop in temperatures may lead to crystallisation of uric acid in the joints,” says Arvind.
Dwelling on the measures that patients ought to take, he informs: “Maintain a regular body temperature in spite of changes in environmental temperature to avoid gout attacks. Drink plenty of water to maintain a consistent body temperature.”
“Uric acid is a heterocyclic compound of carbon, nitrogen, oxygen, and hydrogen with the formula C5H4N4O3. It forms ions and salts known as urates and acid,” says Dr Krishna Prasad, orthopaedic specialist at Capital Hospital in Bhubaneswar.
Talking about gout patients, Dr Prasad observes that the percentage of such patients is low. “If 100 patients visit me in a day there would be one or two victims of uric acid attacks. Its prevalence in the Indian population is 0.1 per cent.”
The orthopaedic specialist says gout is rare in children and young adults. Men, particularly those between the ages of 40 and 50, are more likely to develop gout than women, who rarely develop the disorder before menopause. People who have had an organ transplant are susceptible to gout.
Underlining the causes of gout, Dr Prasad lists a number of factors associated with the disease. These include:
- Genetics: Many people with gout have a family history of the disease. Estimates range from 20 to 80 per cent.
- Weight: Being overweight increases the risk of developing hyperuricemia and gout because there are more tissues available for turnover or breakdown, which leads to excess uric acid production.
- Alcohol consumption: Drinking too much alcohol can lead to hyperuricemia, because alcohol interferes with the removal of uric acid from the body.
- Diet: Daily intake of foods rich in purines can cause or aggravate gout.
- Lead exposure: There are also cases where exposure to lead in the environment causes gout.
Explaining uric acid in simple terms, Dr Srikant Debata, a Bhubaneswar-based orthopaedic surgeon says that when the body breaks down substances found in foods called purines the chemical byproduct is called uric acid.
Dr Debta says gout attacks are not instantaneous phenomena; in fact the disease progresses through four stages, from the silent buildup of uric acid in the blood to chronic arthritis:
- Asymptomatic gout
Uric acid is dissolved in the blood, filtered by the kidneys and passed out through urine. In people with gout, however, this process goes awry. This can happen when you eat too much purine-rich foods, including liver, dried beans, mushrooms and peas.
- Acute gout
The needle-like crystals (monosodium urate, or MSU) that are collected in the spaces within joints are what cause pain in the big toes. They can also affect other joints, including the ankles, feet, knees and wrist.
Acute flare-ups can strike suddenly, often at night, and last from days to weeks. Besides pain, other symptoms include redness, swelling, and generation of heat at the affected joint.
- Interval or inter-critical gout
Uric acid continues to build up in the bloodstream and joint spaces, plotting its next assault. It’s better to consult your doctor on a regular basis.
- Chronic tophaceous gout
This is the most debilitating form of gout. It usually takes a long time to develop — up to 10 years — and is most common in those whose gout is not treated. If your gout is chronic, you may continuously experience symptoms typical of other types of arthritis, including aching and sore joints. In addition, you may develop nodules of uric acid in the soft tissue around your joints. These are known as tophi and are most common on the fingers, elbows, and toes.
Experts say that gout symptoms can be difficult to diagnose because they are either vague or occur as a result of other conditions. A typical gout attack is characterised by the sudden onset of severe pain, swelling and redness of the affected joint. But it is always advisable to consult a doctor before going for medication, as different pathological tests need to be done to confirm gout. Blood tests, X-rays of joints and synovial fluid examinations, which involve taking fluid samples from a joint through a needle and examining them under a microscope for urate crystals, are required to detect gout.
EAT RIGHT
Every gout treatment plan stresses on a diet that helps control uric acid levels in blood. Do not eat foods rich in purines, nitrogen-containing compounds, as they metabolise into uric acid. Follow a well-balanced diet, with special focus to the following foods:
* Eat all vegetables, especially green leafy vegetables.
* Cherries help in reducing uric acid levels and inflammation of the joints.
* Consume plenty of water to keep well hydrated and to filter out the excess waste through the kidneys.
* Low-fat dairy products improve excretion of uric acid. High protein and low purine milk provides a protective effect.
* The citric acid found in lime is a solvent of uric acid. The juice of half a lime squeezed into a glass of water should be taken twice daily.
* Include foods rich in Vitamin C in your daily diet to reduce uric acid in the body. They disintegrate uric acid and force it out of the body through urine. Good sources of Vitamin C are amla, guava, kiwi, sweet lime, oranges, capsicum, lemon, tomato and green leafy vegetables.
* Consume green tea on a regular basis to control hyperuricemia and lower your risk of developing gout.
