Incidence of gout has risen significantly over past 20 years

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By POHLA SMITH

psmith@post-gazette.com

Chris Bauer, 45, had to take disability from his position as a registered nurse at Allegheny General Hospital in Pittsburgh. He doesn't have the strength to lift patients anymore. He can't even push a lawn mower, and the sharp pains he gets in his feet and knees cause frequent falls.

The joints of his feet, knees, elbows and right hand often are painfully swollen, reddened and warm to the touch, and he has big, unsightly lumps of crystallized uric acid under the skin of both elbows and left knee called tophi.

Bauer has gout, a complex form of arthritis caused when the level of uric acid in the bloodstream gets too high and crystallizes within a joint or joints, causing severe pain and swelling along with red, warm skin.

The incidence of this disease has risen significantly over the past 20 years, according to researchers from the Boston University School of Medicine, and now affects 8.3 million Americans, or 4 percent of the population.

"Probably (the increase) is related to health status, in that gout can be seen in all kinds of individuals, from skinny to not-so-skinny," said Larry Moreland, chief of the Division of Rheumatology and Clinical Immunology at the University of Pittsburgh School of Medicine.

Moreland said he tells his patients "that gout is one of the three or four most painful things you can have happen to you. You can have a baby, have a kidney stone or have gout."

The body produces uric acid when it breaks down purines, which are the building blocks for DNA and which occur naturally in the body and in foods.

"There are two general reasons your uric acid level gets elevated," Moreland said. "One is you're making too much uric acid, or you're not getting rid of enough of it through your kidneys. The biggest reason is you're not excreting enough of it through your kidneys, but sometimes with certain medical conditions you're making too much uric acid."

For example, taking diuretics can lead to increased levels of uric acid; so can chemotherapy, which results in a flood of protein and purines, said Dr. Fotios Koumpouras of West Penn Allegheny Health System.

Men are more likely to get gout, though it's uncommon in males under 30, but women become more prone to get it after menopause.

Genetics can play a role in who gets it, Koumpouras said. So do medical conditions such as "kidney problems, heart problems, medication for those conditions and high blood pressure, dehydration," he added.

But gout is treatable and, "it can be cured ... if you can identify the factors that is causing it," Moreland said.

For example, if someone is obese, eating a diet high in purines and drinking alcohol who then loses weight, changes his eating habits and gives up alcohol, his gout may be cured. If gout is caused by a diuretic and the medication can be changed, it can be cured.

"But many people have high uric acid. They do well on medication. Then they stop the medication, and the gout comes back," Koumpouras said. "If it's in your genes, (the gout) has to be managed."

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