The most common type of inflammatory arthritis among middle-aged and older men and, increasingly, women, gout is widely considered one of the most painful physical afflictions known to man. Even women have been known to say it's worse than childbirth.
Recognized throughout human history, gout's famous sufferers have included Alexander the Great, Charlemagne, King Henry VIII and "Piero The Gouty" of the famed Florentine Medici family. Benjamin Franklin at age 74 penned a dialogue in 1780 between himself and "Madam Gout," pleading to know, "What have I done to merit these cruel sufferings?" Gout replied, "Many things; you have ate and drank too freely, and too much indulged those legs of yours in their indolence."
Gout may seem so ... 18th century. But the number of people suffering from the disease here and now has been growing both domestically and abroad. "In the past few decades," according to a recent review published in Nature,
"gout has approximately doubled in prevalence in the USA, and is also
markedly increasing in prevalence in other countries with established
and emerging economies."
That's right: The number of people afflicted with gout, the disease of Charlemagne and Henry VIII, has doubled in our lifetime.
Who is this cruel 'Madam Gout'?
An acute gout attack typically involves a red, tender, "hot," swollen joint. The most common place gout presents, oddly enough, is in the metatarsal-phalangeal joint at the base of the big toe of either foot. Other joints--such as the ankles, heels, knees, wrists and fingers--can also be affected.
H. Ralph Schumacher, professor of medicine at the University of Pennsylvania and editor-in-chief of the Journal of Clinical Rheumatology, explained that urate crystals probably collect in the big toes because the feet tend to be cooler than the rest of the body, and the big toes in particular endure a lot of wear and tear, which can allow crystals to form.
Schumacher said the only "absolute diagnosis" involves inserting a needle in the swollen joint--"with permission"--to look for the characteristic crystals of gout in the egg white-like synovial fluid that lubricates joints and tendon sheaths. "The diagnosis can then be suggested by the typical clinical picture," he said. "It should not be based on only the blood uric acid level."
A normal uric acid range is six parts or less per deciliter of blood. Although a high level of uric acid, or hyperuricemia, isn't considered dangerous, about 10 percent of people with it will develop gout at some point in their lives.
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), as many as 80 percent of people with gout have a family history of the disease. It's far more common in men because the female hormone estrogen appears to protect women against hyperuricemia, at least until menopause.