ARTHRITIS and ATTITUDE GONE BAD

by Earlie Doriman

Gout attack on the big toe. (Photo by yahoo images)

For a long time, I suffered attacks of arthritis – matter-of-fact severe ones because it is gouty arthritis, the most painful of all the rheumatic diseases. You might ask my age now and well, I am only 37 years and that would surely surprise you. You would be more worried to note that I had it when I was 34 years. It had really gone bad that my typical routine, my work, and usual life were so much affected. During the first attack in 2007, I realized it could render me useless. As my big toe was swelling red, I could not lead myself to stand because of the excruciating pain at the joints connecting my toe and feet. It would normally take five to seven days to subside, and I lived in silent agony for that same span, I should say.

Desperate About Gout

More so, it happened frequently. Many mornings I woke up and found out that the gout has explored to other parts of my body, pain here and there, mostly in joints – fingers, knees, shoulders. Joints in my arms and feet started to build lumps and the inconvenience was completely frustrating. I have to buy new pair of shoes because my feet have literally enlarged due to the bulges at the joints. And for the longest time, I was desperate and uncertain. I was on for surgery, for more consultations, and all.

It was primarily because I was a massive stubborn at the start! My wife was like pleading me to take the right medicines but I was simply denying it. I had the prescribed drugs but I only put them aside. I tried to be my own ignorant doctor – an attitude gone bad as well. I even bothered my brother in the Philippines to send me some herbal tablets that claimed effective and easy healing to my condition, but even with loads of those China made capsules, remedy was to no avail. When attitude has gone bad, my condition has gone worse.

My Wife is Right

So finally, with my wife almost at the verge to give up prodding, I took the doctor’s advice and went regularly for my check-up. The blood test revealed that my urate level was very high, the main reason of the frequent attacks.  I was referred to Dr. Smith , an excellent rheumatologist at Rochdale Infirmary and he gave me a higher dosage of the medication, reminding me to take it as advised. He is brilliant to explain everything about gout and the risks that go with it. It would take a little longer to see the lumps subsiding and eventually the urate to come back to a normal level.

I am particularly happy now. No more severe attacks and the lumps building up in my joints are almost unnoticeable. My wife was in fact right from the very beginning. I was only in denial. Once you have gout, it would stay forever, but the attacks could be prevented by proper medication and correct diet. It is a responsibility now. I am still stubborn but I do take my medication religiously and I know it is for good.

The Medical Perspective

What causes gout? At the onset of my gouty arthritis, many people told me to avoid alcohol or eating beans and food that are rich in protein because they are the primary causes of gout attacks. They might be correct at some point, but medicine has a very detailed explanation why.

Gout is most frequent in men and it can affect to any age. Whilst it is true that if you stuff yourself too much with  alcohol or food, attacks of gout are more likely to occur, but that is not the entire story.  People will suffer gout because there is rather unusual in the chemical processes, which take place within the body. A substance which is called ‘URATE’ can build up as crystals in joints. When these crystals are deposited in a joint, they cause inflammation – the joint becomes red, hot, swollen, and extremely painful. Urate can also collect under the skin, most particularly on ears forming small but firm bulge called ‘TOPHI’.  

So where does urate come from? It forms as a final product of various chemical processes within the body.  All of the cells in the human body, and many of the foods we eat, contain substances known as ‘PURINES’.  As old cells are broken down or as food are digested these purines are converted to uric acid, which is carried in the blood as a salt called Urate.  It is actually healthy to have some urate in the bloodstream.  Its presence does not itself lead to gout, and even people with higher than normal levels of urate may not go on to develop gout.  When the amount of urate in the blood rises, the body normally rids itself of the excess through the kidney into the urine.  If this does not happen, the urate continues to increase until it reaches a level at which urate crystals can start to form. Urate crystals are fine needle-shaped crystals that may collect in the joints or under the skin.

What are the reasons why urate is not effectively washed out of the body? Gout is also genetic and therefore may run in the family.  There is an inherited tendency where your kidneys retain more urate than average. But this does not mean you have a kidney disease. Well, if you have, it may mean that your kidneys are not able to process urate effectively as they should.  If you have blood disorders where the body produces too much blood cells, as these cells are broken down they may release urate into the bloodstream more quickly than the kidneys can cope with.  Drugs such as diuretics, which drain water from the body may increase urate to a level which the kidneys can not handle efficiently.

Are there long-term risks of gout? Few attacks of gout will not cause permanent damage to the joints and a complete recovery can be expected.  However, when joints are repeatedly attacked by gout, the crystals can damage the cartilage and bone of the joint. This is not exactly the end of your happy days because the availability of modern medical treatments plus a serious look out of your diet can repair the damage eventually.  Just be very careful that when you already have attacks of gout, it is more likely associated with high blood pressure, diabetes, heart disease, and hyperlipidaemia or too much fat in the blood. It is always good to check this aspects of your health.

What Treatments are available? There are non-steroidal anti-inflammatory drugs available through doctor’s prescription. These are basically drugs that relieve pain and help reduce inflammation (such as Naproxen, diclofenac, and indometacin), they do not prevent the occurrence of gout attacks. There are also urate-lowering tablets (like Allopurinol) and the purpose of these drugs is to reduce urate levels in the blood.  This will eventually drain the deposits of urate in the joints and other parts affected by gout. Some drugs to wash out excess urate are also available through medication.

Reference

Gout: An Information Booklet

ARC: Committed to Curing Arthritis

www.arc.org.uk

February 2008