“A left hand preserved
intact to show advanced Gout. It is markedly shortened, mainly due to the
changes in the fingers, and it is grossly deformed. Removed, at post-mortem,
from a man aged 64 who had previousoly been a professional footballer”
Gout was
once considered “The Disease of Kings” or “The Rich Man’s Disease” as it was
highly prevalent within in social classes who could afford to binge on rich
foods and wine. Because of this reputation, Gout was portrayed as a humorous
disease and was satirised in many ways, such as these caricatures by James
Gillray
The
reality is that gout is an incredibly painful condition and, in today’s lazy
junk food-laden society, it is on the rise.
Gout is a
type of arthritis (inflammation of the joints) which is caused by high levels
of uric acid in the blood. The main joint affected is the metatarsal-phalangeal one at the base of the big toe, and in this
instance the disease is also called Podagra.
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| Early Gouty changes |
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| Advanced Gout |
However, many other joints can be affected by these uric acid deposits (heels,
knees, wrists, elbows and fingers) and their placement can have a severe impact on
independence and mobility. This specimen is one of five from the same patient. It is a hand, removed after death, to show the disfigurement that can be caused by severe Gout:
As well as
this arthritis, (remember ‘arthro’ means JOINT which is why
arthropods are jointed creatures like arachnids and crustaceans, and anything
ending in ‘-itis’ is INFLAMMATION:
appendicitis, colitis, tonsilitis etc)
Gout will also present as tophi, renal calculi and renal insufficiency. Tophi
and calculi are both types of ‘stones’ created in the organs and joints by
these uric acid deposits (you can see them above in the 'advanced gout' picture. We have many examples of them here in the
Pathology Museum. In fact, the first specimens ever introduced to Barts Medical
school museum were urinary calculi or bladder stones. Renal insufficiency is
poor kidney function, caused by the placement of these stones. Various other
co-morbidities exist alongside Gout such as hypertension, diabetes and obesity.
This list tells me straight away that Gout is usually caused by bad diet and
lack of exercise, so you can see why it was labelled a silly disease that the
rich brought on themselves. However, our diet nowadays is very rich in
comparison to theirs and this is why gout is becoming increasingly common. The rates in
the UK doubled between 1990-2010.
Men are six
times more likely to suffer from it than women and it particularly affects
those whose diets are rich in purines (natural substances which are metabolised
into uric acid). The foods with the highest
purine levels are anchovies, brains, kidneys, liver, sweetbreads and
sardines. I have to say, I would reject any of those things from my daily menu anyway
so I feel quite safe! Incidentally, has anybody made a movie yet about the
blight of gout amongst zombies because surely they are at high risk?!
There are also high levels in bacon,
beef, lobster, salmon, tuna, turkey and even legumes such as kidney beans and
lentils – so even vegetarians aren’t safe (for once!) The consumption of
alcohol and fructose-sweetened drinks is also responsible for the increase, as
well as not drinking enough water. It makes you look at your steak, chips &
beer in a different way, doesn’t it?
The good
news (for fellow caffeine addicts) is coffee helps protect against gout, as do cherries both sour and sweet. As with all things, balance is key. Stick to a healthy diet 80% of the time and
there’s no reason you can’t treat yourself 20% of the time. To me, the above sounds like a great excuse for a latte and a piece of Black Forest Gateau! And remember to
stay active. Leading a sedentary lifestyle is one of the major causes of the
comorbidities associated with gout, such as high blood pressure.
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| The Gin Lane Gazette - Adrian Teal |
