Читать книгу Arthritis For Dummies - Barry Fox - Страница 86

More than eight million Americans suffer from gout. In younger populations, gout affects men more often than women, but women catch up to them after menopause. Officially known as acute gouty arthritis, the problem usually begins with a sudden, overwhelming “assault” on a joint. You may go to bed feeling fine with no inkling of trouble ahead only to wake up in the middle of the night with excruciating pain in the “bunion joint” of your big toe. The joint is stiff and warm to the touch, and swelling lends a shiny, tight, reddish or purplish look to the skin, which is tightly stretched over the area. Sometimes the joint is so inflamed and tender that even the touch of a bed sheet causes agonizing pain. You may also have a fever, chills, a rapid heart rate, and a general blah feeling.

Gout is linked to excess levels of uric acid in the blood (known as hyperuricemia). When the blood has more uric acid than it can handle, the body may convert the excess into sharp, pointed urate crystals and store them in one or more joints. Since these urate crystals don’t belong in the joints, the immune system tries to clean them up, resulting in pain and inflammation. See Figure 4-1 for an example of what these crystal deposits look like in a joint.

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FIGURE 4-1: Crystal deposits in a gouty joint.

The joint at the base of the big toe is quite often the first site that gout strikes. The elbows, wrists, fingers, knees, ankles, heels, and instep may also be attacked during the first or subsequent bouts, while the shoulders, spine, and hips are rarely touched. No matter where gout strikes first, there’s about a 75 percent chance that it will affect the big toe at some point.

Your first attack of gout may also be your last. Or, it may herald the beginning of a series of attacks on that joint and/or others, leading to progressive and irreversible joint injury. Fortunately, medical treatment can help ward off recurring attacks while preventing or minimizing permanent joint damage. In this sense, gout is really the only curable form of arthritis — so long as you take your medicines as directed every day! If you want to guard against gout, your best strategy is probably to be born female. Women’s uric acid levels are naturally lower than men’s until they reach menopause. Then their uric acid levels start to rise, although it can take up to 20 years before they equal the levels seen in men.

Several situations are linked to an excessive amount of uric acid in the blood, including the following:

 Genetics — Approximately 20 percent of those with gout have a history of the disease in the family.

 Taking drugs that can lead to increased uric acid (such as diuretics, aspirin, nicotinic acid, levodopa, and cyclosporine).

 Blood cancer or other diseases that cause the rapid multiplication and destruction of body cells, leading to higher levels of purines and uric acid.

 Chronic kidney disease which hamper the kidneys’ ability to filter out uric acid.

 Drinking too much alcohol (beer or grain liquors, including whiskey and vodka) and/or eating or drinking foods that contain high-fructose corn syrup may also play a role in initiating gout.

To a lesser extent, eating lots of foods containg a high amount of purines such as red meat, lamb or pork, organ meats, shellfish, and certain fish (including anchovies, sardines, mussels, codfish, and herring), may stimulate the body’s production of uric acid. Gout is also associated with high blood pressure, heart disease, diabetes, high levels of cholesterol, and obesity.

Though the disease becomes apparent when excess uric acid in the blood is converted into a crystalline form and deposited in the joints, elevated uric acid alone doesn’t cause gout. Many people with excess levels of uric acid never get the disease, while others who suffer from terrible gout-related pain may have fairly standard amounts of uric acid. It’s also possible to have fully formed uric acid crystals deposited in a joint or two yet feel no pain at all.