Achy Bones: Gout

Last week we talked about osteoarthritis because it affects the biggest group of arthritis sufferers.  About 20 million people in the U.S. have doctor-diagnosed arthritis.  If you look at statistics 5 years ago more people had arthritis than they do today.  You have to scratch your head over that.  Well, the CDC changed the criteria.  Back then it was people reporting joint pain and arthritis.  Today it has to be physician-diagnosed.  All of a sudden the numbers when way down from 50-60 million people to 20 million people. If you’re looking at numbers, according to what vintage your numbers, they will vary dramatically. 

This week and next we’re talking about the next two most prominent types of arthritis: gout and rheumatoid.  Rheumatoid gets our attention more because it’s so chronic and debilitating.  There are actually twice as many people who have gouty arthritis than rheumatoid.  I guess it’s a good thing since gout is more treatable.

Then there’s another group of people, nearly as many as have gout, and twice as many as have rheumatoid.  These are people that have fibromyalgia.  That’s been now kind of included in the arthritic “family” if you would.  By the way  90% of fibromyalgia patients are women.  Doctors were telling women just a few years back that they were hypochondriac or that it didn’t exist.  But we were, as a group of physicians, disrespecting women and ignoring their symptoms.  Much worse than that, impugning them by suggesting that it was only in their minds.  I ask forgiveness but I can’t speak for the rest of the medical community

Today we’re going to talk specifically about gouty arthritis.  Gouty arthritis is a situation in which uric acid builds up in the system and it forms crystals.  The solution becomes super-saturated with uric acid and so it crystallizes.  If you put too much sugar in your tea and keep putting more and more sugar in until it’s in solution while the tea is warm, when you put it in a refrigerator it can actually precipitate out.  The same reason honey goes to sugar after a while if it just sits there on your shelf.  It will crystallize.  That’s the type of situation we have here: crystallization.  

When there is too much uric acid in your system, your kidneys aren’t clearing enough.  That can be a genetic predisposition and can also be a situation where it’s environmental to some degree, in the sense of what we’re eating.  If we’re eating to many rich foods, too much meat with fat in it that can contribute to gout. Alcohol can also precipitate gout.  In the past it was known as the rich man’s disease, back as early as the 1500’s.  These were people who were able to afford lots of wine and ducks, fatty foods and things like that to eat.  

Gout is crystals that form in the joint space.  These little crystals are just like if you’ve ever gotten into fiberglass.  It itches.  It irritates.  This is kind of like fiberglass in your joints.  These pointy little crystals just irritate the heck out of the synovial lining.  As a result it becomes inflamed. 

Gouty arthritis usually occurs in one joint to begin with.  If you’ve got one joint that’s inflamed and hurting then the first question in your mind should be whether it’s gout.  The body demographics have changed over the years.  First-time attacks occurred 70-80% of the time in the great toe.  But in recent years that’s decreased.  We’re getting much more in the knees and elbows and hips these days than we did in times past.  It’s interesting to see that for centuries it stayed the same with the great toe being the fist joint to show up and then it’s changed a little bit.

Standard medical treatment for gout is non-steroidal anti-inflammatories that we talked about the other day.  Then some treatment drugs are Probenecid and sulfuric tyroione,  Allopurinol and things like that.  They do a fairly effective job of taking care of gout and keeping the uric acid out of the body.  Natural treatments include curamin, MSM, and digestive enzymes.  Digestive enzymes are interesting because if you put them in the bowel with food, they help digest food.  But if you take them on an empty stomach they go into the blood stream and are very anti-inflammatory there.  Black cherries as an old-wive’s treatment are known to help gouty patients.  We don’t know the mechanism because none of the big labs are going to put a couple million dollars into research in that.  It’s probably not patentable.  

Then just recently in the last year I’ve heard of a gentleman who stumbled across, just by the power of association with his own personal experience, that baking soda helped his gouty arthritis.  He mentioned it to other people who had gout.  They used it and so this has become another “ma and pa” treatment.  I just personally treated four or five patients with bicarbonate.  It’s worked on every one of them.  It’s an intriguing, new, alternative, very inexpensive treatment which you can find in any grocery store, probably in your own cabinet in the kitchen.  That’s interesting to see how that’s going to turn out and what percentage of people are benefiting over time. 

I'll talk early next week about a third type of arthritis: rheumatoid arthritis.