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Gout is an important disease of the elderly.

goutIt is a disease that has been with our history for a long time. Since 2640 BC. The Egyptians defined a disease characterized by acute inflammation of the big toe joint as 'Podagra'. Later, the Greek physician named Hippocrates (Hippocrates) called diseases with similar characteristics that 'The Unwalkable Disease', which the symptoms indicate are all consistent with current gout.

In ancient times, gout was known as The Disease of Kings or Arthritis of the Rich because it is a disease caused by eating too much food and drinking alcohol. This is the way of life of the rich only. Therefore, there was a trend for men in the past to eat and drink to make themselves suffer from gout.

The word gout comes from the Latin word 'Gutta' which means 'Drop', meaning 'to flow down or drip', comparing it to phlegm flowing down and collecting in the joints. Causes pain and inflammation in various joints in the body.

What is gout?

Gout is more common in men than in women. It is caused by the accumulation of uric acid in various joints of the body, especially joints with low temperatures around 20 degrees Celsius, such as the knuckles of the fingers, ankles, big toes, and feet. (Metatarsophalangeal Joint) In some people, there may be high uric acid in the blood but no symptoms. We call this characteristic Asymptomatic Gout and when there is acute pain or Acute Gout condition. Attack involves symptoms of arthritis, pain, swelling, redness, and heat. The pain can last 3 to 10 days. If the patient is not treated and the pain is allowed to continue, it will cause chronic gout until the formation of lumps or tophi, which will rub and cause damage in our joints.

When the level of uric acid in the blood is high Uric will precipitate around joints, causing inflammation and the production of substances C3a and C5a, which can induce white blood cells to enter the area of inflammation. It produces substances such as Interleukine-6 and TNF-alpha, causing more and more inflammation, destroying joints, tendons, and cartilage as a result.

Diagnosing gout

water penetration into joints or tophi to check for uric acid crystals
There is pain, swelling, redness, and heat of the joints.
Measure uric acid levels in the blood. (Men's values are greater than 7 mg/dL and women's values are greater than 6 mg/dL.)

Medicinal treatment by medical specialists

Medicines used for treatment are divided into 2 main groups.

Medicines to reduce joint inflammation include non-steroidal anti-inflammatory drugs (NSAIDS), colchicine, and steroid-based medicines to reduce severe inflammation. (Corticosteroid) used only for the short term.
Medications to prevent gout attacks Important drugs that reduce uric acid production, such as Allopurinol (Xanthine Oxidase Inhibitors) and drugs that increase uric acid excretion through the kidneys (Probenecid), etc.

Causes of gout

Obesity: When the amount of fat in the body increases. This results in increased uric acid production. Including decreased elimination of uric acid through the kidneys.
The elimination of uric acid from the body is slower or less than normal. from kidney failure or taking certain medications, such as diuretics or aspirin
drinking alcohol As a result, the level of uric acid in the blood increases. Research suggests that drinking 1-2 servings of alcoholic beverages per day Increases the risk of arthritis (Gout Attack) by up to 36% and increases the chance by up to 51% when drinking 2-4 servings per day.
Eating foods high in purines includes organ meats, seafood, shellfish, fish and some types of meat. or eating excessive amounts of meat
Drinks containing fructose, such as sugary drinks and fruit juices, can increase uric acid levels in the blood.
Congenital diseases such as diabetes, high blood pressure, kidney disease, thyroid disease, cancer or patients receiving chemotherapy which causes the destruction of cells in the body
Stress, because increased stress hormones cause inflammation in the body. and triggers gout.
Genetic history, such as relatives with a history of gout Resulting in abnormalities in the creation and excretion of uric acid. Currently, research has found that gout can be detected by genetic code, such as genes SLC2A9, ABCG2, FAM35A, etc.

How to reduce uric acid levels in the blood

Take care of your body weight appropriately. Maintain body fat mass within normal limits. It should be less than 28% for men and less than 32% for women.
Drink enough water, at least 2 liters, to allow the body to excrete uric acid through the urine.
Avoid foods that increase uric acid levels, including:
- All types of alcoholic beverages especially beer
- Offal of all animals, veal, venison, pheasant, turkey, bacon.
- Fish and seafood include sardines, anchovies, mackerel, herring, tuna, salmon, trout, shellfish, etc.
- Foods and drinks that are high in fructose, such as sweeteners, fruit juices, and honey.
Choose to eat the right amount of low-fat meat. Because of eating too much meat This results in high uric acid levels in the blood.
Eat fruits and vegetables that have little sugar. Research shows that eating vegetables high in purines does not increase the risk of gout. And eating fruits and vegetables can also help reduce inflammatory processes in the body.

Reference source

Nuki G, Simkin PA. A concise history of gout and hyperuricemia and their treatment. Arthritis research & therapy. 2006;8(1):1-5.
FitzGerald JD, Dalbeth N, Mikuls T, Brignardello-Petersen R, Guyatt G, Abeles AM, et al. 2020 American College of Rheumatology guideline for the management of gout. Arthritis care & research. 2020;72(6):744-60.
Choi HK, Atkinson K, Karlson EW, Curhan G. Obesity, weight change, hypertension, diuretic use, and risk of gout in men: the health professionals follow-up study. Archives of internal medicine. 2005;165(7):742-8
Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G. Purine-rich foods, dairy and protein intake, and the risk of gout in men. New England Journal of Medicine. 2004;350(11):1093-103.
Neogi T, Chen C, Niu J, Chaisson C, Hunter DJ, Zhang Y. Alcohol quantity and type on risk of recurrent gout attacks: an internet-based case-crossover study. Am J Med. 2014;127(4):311-8.