The Prairie Doc

Gout and the agony of the feet

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It is a classic presentation: The middle-aged man who develops a painful, swollen, great toe the morning after indulging in a steak dinner with a few beers. The savvy clinician will immediately identify this diagnosis, and I imagine much of the general public might recognize it as well. It’s “The Gout.”

Gout is a unique type of inflammatory arthritis in which a substance called uric acid, accumulating in too-high amounts in the bloodstream, forms crystals within a joint. The presence of those microscopic crystals causes the immune system to attack the “foreign” substance, and the result is excruciating pain. I have seen many a patient limp or be wheelchaired into the exam room when this process occurs in their toe, ankle, or knee. In the most severe cases, patients might be admitted to the hospital.

Gout has been recognized as a disease for many centuries, being described in ancient Egyptian texts in 2600 B.C. and later by the famed Greek physician Hippocrates around 400 B.C. It was once known as the “arthritis of the rich,” and the “disease of kings,” given its propensity to occur after consuming rich food and alcohol. Uric acid crystals were first visualized under a microscope in 1679, during the microscope’s early years, by another famous historical scientist, Antoni van Leeuwenhoek. The chemical composition of what he saw, however, was not known until more than a century later.

If you have had the agony of experiencing a gout attack, know that you are in excellent company. Both Benjamin Franklin and Thomas Jefferson were known to suffer from gout, and historians have speculated that their shared experience led to their strong connection at the time of the American Revolution. In fact, reports are that Franklin, unable to walk due to a gouty attack, was carried on a chair into the Constitutional Convention by convicts. Western history and literature are full of references to “The Gout.”

Today, gouty arthritis is a fairly common disease. It tends to affect men more than women, and generally occurs in middle-aged and older adults. Treatment of the acute episode is fairly simple; often we just use anti-inflammatory medication. In patients who have recurrent problems with gout we consider daily medication that lowers the level of uric acid in the bloodstream altogether, which is typically highly effective.

“The Gout” of ancient times was a life-altering condition and as such found its way into many historical texts and literature. Today, well, it’s just gout. And usually, we can treat it very effectively.

Kelly Evans-Hullinger, M.D. is part of The Prairie Doc® team of physicians and currently practices internal medicine in Brookings, South Dakota.

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