Gout, the ‘mature-people’ disease that is now creeping to the young

How does one develop gout?

Gout is a metabolic disease caused by excessive uric acid crystals. When they are in excess, they deposit in tissues, most times in the joint(s) which later cause inflammation. That inflammation is characterised by severe pain, swelling and redness.

Do these uric acid crystals deposit anywhere else in the body?

Joints are the commonest but they can deposit in the kidneys, and so we see patients with gout presenting with kidney failure; they can also deposit in the ureter (the tubes that aid passage of urine). Excessive uric crystals can also damage blood vessels, so you find these patients also being at risk of cardiovascular complications.

What causes this increase in uric acid?

It could be that the body is producing excess or the body is not removing the excess as required which is what we call under excretion of uric acid. For example, if you have a problem at the kidney level and the kidney is not removing the uric acid as required, some of it can accumulate and cause a problem later or earlier.

What factors contribute to one developing gout?

One of them is kidney disease, since those affected are at risk of under excretion of uric acid. Obesity is also a risk factor, excessive consumption of alcohol, and consuming foods rich in purines.

What are purines?

Purines are part of DNA. Usually when they are broken down the final product is uric acid which is the cause of gout.

Does genetics play any role in developing gout?

There are some genetic disorders that are a risk factor for gout which we see in young people. You will therefore tend to see gout running in families in such cases.

Can use of certain medication also increase the risk of developing gout?

There are certain water pills that are used for heart disease or hypertension which can put one at risk of getting gout.

Gout has been known to affect more adults; are there cases that involve children?

Gout tends to be very rare in children; we hardly see cases except when they have those genetic abnormalities of metabolism. However, we are seeing lots of lifestyle changes with obesity being prominent in our population and hence in younger adults even in their 20s, whom previously we did not see much of gout, we are beginning to see early onset of the disease.

What is the driver for this?

Mainly is the lifestyle, we see people drinking a lot and consuming unhealthy foods.

What are some of the symptoms of gout?

Gout is one of the most dramatic diseases somebody can have. It gives people real pain. When we talk to patients they tell of the kind of pain they have never felt in their lives. That is pain that will wake up somebody from sleep and usually it lasts between one to two weeks. Pain (in the joints) is the commonest of symptoms. Others are kidney failure.

How quick or slow does gout develop?

Usually a gout ‘attack’ will appear very suddenly. This we call an acute onset of presentation. Somebody could go to sleep okay and some pain wakes them up at night.

Can gout lead to amputation of a limb?

It will be very rare unless one has (very) long standing gout in the joint which complicates with an infection affecting the tissues and bone. This is a very rare occurrence though. What gout will lead to is disability especially when it affects a joint over a long period of time. Each time you have an attack, then you have some significant joint damage that happens.  When this damage is accumulated, then you can get significant deformity.

Does this mean gout can reoccur even after one gets better?

Treatment of gout is not a one-off thing. Patients need to be in a chronic care clinic, which means there need to be continuation of follow up. Usually we treat that one episode –gout is that episode of pain; but remember what causes gout is the excess uric acid called hyperuricemia and this is a chronic illness. So if you treat hyperuricemia, then people do not get gout. Once you maintain a normal uric acid balance, then you can sort out gout.

What is the process of treating gout?

We first usually deal with the acute pain that has brought the patient, which is most times in the joints. For this we use antiflammatory medication which are common like diclofenac and brufen. At times the inflammation is so much that you have to use steroids. The next step is to treat the disease and there are medication for that which should not be stopped once the symptoms clear.

Why is it that men are more affected by gout?

Gout tends to affect men more than women. The reason for this is we think the oestrogen hormone, which more presented in women is protective against gout. This does not mean that you cannot encounter gout in women. However for women after menopause, the risk of gout is equal to men of the same age so the risk balances at that point.

How early or late do patients present to hospital with gout?

Gout presents with severe pain, so patients will always come after an attack. But often times we have some patients who have had gout attacks continuously so they know how to manage themselves. I have seen men walking around with a pack of diclofenac and they pop a pill and that episode of gout clears.

What is the danger with self-medication?

Sometimes these patients who pop pills will develop complications. Just like the gout, the diclofenac you take can injure your kidney so you get such patients end up with kidney failure, severe gout and lots of disabilities.

Can exercising reduce severity or risk of developing gout?

Exercise is good for anyone who has joint pain or problem. As you make the joints mobile through exercise, you are increasing the strength of the tissues. There are however other precautions for patients of joints like ensuring the joints are well lubricated through fluid intake which also reduces the concentration of uric acid in the body.

Is it true nyama choma causes gout?

This is one of the stigmas associated with gout. People relate gout to intake of nyama choma and heavy consumption of alcohol. Yes, we know those things have some a high burden of purines hence when you are susceptible to getting gout, and you indulge in them, then you can easily tip over to a gout attack. However, there are many people who do not take alcohol or overindulge in nyama choma but they still get gout –because there is a lot of uric acid produced in your body from other sources like purine being part of your DNA, when broken down, you will still get uric acid.