Throughout history, there are characters in literature who suffer from painful conditions. I have read many variations of Pride and Prejudice character Mr Hurst enduring painful joints.
Recently, I spent a horrible night in severe pain and ended up going to the emergency room. I thought for sure that I had broken my big toe or some bone near the joint. What it turned out to be was gout. In reading more about gout, I was shocked.
Did you know that gout is a form of arthritis? And it can settle in any area in the body, but the big toe is the most common?
Gout is crystals that build up due to excess of uric acid in the body. If the crystals are not dealt with, over time, the crystals can cause deformities in joints, and can cause damage to the joint, to tendons and tissue as well.
The first identification of gout as a disease was in Egypt in 2640 BC. Hippocrates referred to it as ‘the unwalkable disease, and believed it to be an excess of one of the four humors, leaving the equilibrium in the body. It was also believed to be a disease of the wealthy (I wish it was the case in my life), as gout was usually found in those of such lifestyle.
Physician Thomas Sydenham described it as follows: “A pain which usually seizes the great toe, but sometimes the heel, the calf of the leg, or the ankle. The pain resembles that of a dislocated bone… the pain is mild in the beginning, grows gradually more violent every hour to become so exquisitely painful as not to endure the weight of the clothes nor the shaking of the room from a person walking briskly therein.” Having just suffered from it recently, I can believe it completely, as I felt this way.
It was first described in appearance by Antoni van Leeuwenhoek (1632-1723) who was one of the pioneers of microscopy, when he viewed the crystals from a gouty tophus, stating that what appeared to the eye like chalk, was in fact transparent little particles that were pointed at both ends.
The risk of developing gout are higher for people who are overweight, drink too much alcohol (Mr Hurst), eat lots of meat (especially organ meats like liver, kidneys, sweetbreads, brains) and fish high in purines(anchovies, sardines, herring, mackerel, scallops), gravies, and even diuretics and aspirin can bring on gout (having congestive heart failure, I have to keep my fluid intake down, yet if I keep the fluid level down, have higher chance of gout attack). Even oatmeal, wheat bran and wheat germ can bring on gout. Men are more likely to develop gout than women. There is also a higher chance if you have diabetes, kidney disease, lead poisoning, heart disease, injury to a joint, an illness or infection, rapid weight loss, if you have surgery, and if you have high blood pressure.
Besides pain, the area might appear as if there was an infection in the joint, redness and warmth may also be present. The flare ups are more common to start at night and rapidly worsen. There can also be limited movement in the joint, and itching and peeling of the skin in the area. If in the elbow or knees, there might be inflammation in the fluid sacs that cushion tissues (bursae). This is known as bursitis, olecranon bursitis in elbow and prepatellar bursitis in knee. There can also be nodules (tophi) on the hands, elbows, or ears that might first appear.
Foods you can eat safely contain low purines include green veggies, tomatoes, fruits, non whole grain breads and cereals, butter, buttermilk, cheese, eggs, chocolate (YAY!!), cocoa, tea, coffee, carbonated drinks, peanut butter and nuts. Low fat milk and low fat yogurt may aid in reducing your risk of gout.
There are medications that can be taken if you have had attacks. Colchicine is still commonly used. Meds called xanthine oxidase inhibitors can be used, helping to shrink the tophi. If the gout has lasted a long time and not controlled by other treatment, a medication called pegloticase can be used. Surgery is rare, usually to remove large tophi that are causing deformity. My mother has had surgery twice on her ankle to remove tophi, and they continue to form. If there is swelling in a large joint that is causing pressure, a doctor might use a syringe to withdraw fluid (aspirated).
Some of the natural supplements that might help as well are cherries (tart cherry is a known anti inflammatory), devil’s claw, omega 3 (flaxseed oil), and folic acid may be helpful in inhibiting the enzyme needed to produce uric acid.
Most animals produce uricase, which helps to break down uric acid. Humans and great apes do not produce the uricase. Interestingly, fish are one of the animals that has uricase, yet fish can cause an attack. There is a T-rex skeleton that led to the belief that the dinosaur suffered from gout (no wonder they were so foul tempered, they were suffering painful gout).
In history, we have people such as Ben Franklin, who was crippled by gout. Dickens wrote about characters with gout in Bleak House and The Pickwick Papers. But I found Hippocrates 5 aphorisms to be quite interesting:
Eunuchs do not take the gout, nor become bald.
A woman does not take the gout unless her menses be stopped.
A youth does not get gout before sexual intercourse.
In gouty affections, inflammation subsides within 40 days.
Gouty affections become active in spring and in autumn.
So there is an overall view of gout. Please note that I am not a doctor, and do not suggest anyone using treatments without consulting a physician. Talk to your doctors before taking any supplements to avoid interactions with medications.