It may sound like a disease that plagued kings in the Middle Ages, but gout still afflicts 2.1 million Americans today. Health spoke to Dr. Rodney Bluestone, a rheumatologist and clinical professor of medicine at UCLA who sits on the board of directors of the Southern California chapter of the Arthritis Foundation.
Question: When I think of gout, I picture King Henry VIII at a banquet table, propping up his red, swollen foot on a velvet stool while he eats overly rich foods. But that's a bit one-dimensional, isn't it?
Answer: Certain foods are associated with gout. Liver, sweetbreads, lots of red wine. But usually diet by itself isn't enough to bring it on. In fact, it's very hard on a contemporary American diet to get gout unless you want to do a King Henry VIII imitation--he would consume a side of venison and six bottles of red wine a night.
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Q: So then what causes it?
A: Gout, or gouty arthritis, is the acute inflammation of a joint caused by the crystallization of uric acid in that joint--and 90% of the time it's in the big toe, although it can spread to the rest of the foot. We don't know why. There's a theory that the big toe gets traumatized just by walking around, because it's such a high pressure-bearing area in your body.
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Q: Could you define uric acid?
A: It's a chemical produced by the liver that circulates in your bloodstream. It's useless and has no function whatsoever. With most people, uric acid is excreted from your system. But some of us, for reasons that aren't known, make too much. When uric acid exceeds the limits of solubility in the blood, it gets deposited in a crystallized form in a joint or a tendon sheath. The body's white blood cells see the crystals as foreign invaders and try to attack them, which releases cellular enzymes into the joint that cause a tremendously painful response. People feel their toe is glowing like a red-hot balloon. They can't stand the weight of bedsheets. While it's comical to talk about, it's agony to suffer.
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Q: How has treatment advanced since King Henry VIII's time?
