Pain of Gout Hits More Americans: Study

Greg Hannoosh's battle with gout began 10 years ago with a severe pain in his foot in the middle of the night.

"I remember waking up in the night with soreness and pain in my right foot," said 51-year-old Hannoosh of West Newbury, Mass. "The pressure from my sheets was even causing pain."

The next morning, Hannoosh recalled, "The pain had spread [from my right toe] to the point that my whole foot was not useable. I couldn't walk and couldn't wear shoes. It was pretty debilitating."

Hannoosh saw his doctor, and lab tests revealed high levels of uric acid in his blood. The bad news followed -- doctors diagnosed him with gout, an incapacitating condition in which crystal forms within the joints, causing inflammation and pain.

In gout, the pain is not constant, but rather presents in episodes called gout attacks -- a fitting term, according to Hannoosh.

"They called it a gout attack because it is just like an attack; you are being invaded," he said.

Now, new research suggests more and more Americans may be sharing Hannoosh's struggle against the pain of gout. A new study published Thursday in the journal Arthritis & Rheumatism reveals that the prevalence of gout in the United States has risen over the last 20 years and now affects 8.3 million Americans -- compared to just 6.1 million two decades ago.

The study was supported by Takeda, the pharmaceutical company that makes the gout drug Uloric. Researchers compared data collected from a survey of Americans in the latest U.S. National Health and Nutrition Examination Survey (NHANES) between the periods of 2007-2008 to a previous NHANES surveys conducted in 1988-1994. When the study took into account factors such as obesity or hypertension away from the results, the numbers of people with gout lessened -- a hint that lifestyle choices may be at least part of the problem.

"The burden of gout and hyperuricemia continues to be substantial in the U.S. population," said lead study researcher Dr. Hyon Choi, a rheumatologist and professor of medicine at Boston University School of Medicine.

"The prevalence of gout rose from 2.7 percent two decades ago to an increase of 3.9 percent. Although that seems like a small number, it is actually a 44 percent increase," Choi said. "Obesity and hypertension are main contributing factors."

But though obesity and hypertension may be contributing factors, they are not the only factors involved. High uric acid blood levels, diabetes, high cholesterol, dehydration, alcohol intake, a high-protein diet and the side effects of certain medications such as diuretics can add to a person's risk. Genetics can also play a role.

"Certainly a key take away [from this study] is that many patients with gout have multiple other conditions, such as obesity, hypertension, kidney disease, diabetes mellitus, coronary disease or metabolic syndrome, which must be considered in the management of gout," said Dr. Theodore Fields, rheumatologist at the Hospital for Special Surgery in New York.

"The public needs to realize that this is one more nail in the coffin about the importance of obesity and cardiovascular disease." said Dr. Eric Gall, rheumatologist and director of the Arizona Arthritis Center in Tucson."They need to also know that the treatment for gout is not just lowering the uric acid but also paying attention to diet and exercise."

For Hannoosh, treatment meant going off of his blood pressure medication, as doctors believe it may have contributed his gout. And he made lifestyle changes as well.

"I don't drink beer anymore and don't eat near as much red meat as I used to," he said. "I also drink a lot more water than I did before."

The measures may be working; Hannoosh said his last gout attack was about two and a half years ago.

By MERCY EDIONWE, M.D.
July 28, 2011