The unwalkable disease

by Ruth Nichol / 01 October, 2015
Long dismissed as the price of overindulgence, gout is now known to be genetically determined.
Gout Micrograph
This polarised light micrograph of uric acid crystals in the joint fluid of a gout patient may look pretty, but the disease can be very ugly. Photo/Getty Images


First-time gout sufferers may not know what gout is but they certainly know something is wrong: one day they feel fine; the next they’re in agony.

“The classic first presentation is in the big toe,” says Christchurch rheumatologist Lisa Stamp. “It’s red-hot and swollen and extremely painful. Many people think they’ve broken a bone, because they can’t walk.”

Gout attacks typically come on overnight, but they are the result of a much longer process. Gout, a type of arthritis, is caused by high levels of uric acid in the blood. The acid turns into crystals in the joints – not only the big toe, but also the knees, elbows, wrists and fingers – and can produce excruciating pain.

Most gout attacks settle down quickly. However, unless it is treated with drugs to lower uric acid levels, it can become chronic and may cause permanent joint damage. It’s also associated with other diseases, such as diabetes, heart disease and kidney problems.

Known for centuries as the “disease of kings”, because it can be triggered by consuming red meat, seafood and alcohol, gout is poorly understood. But it’s now clear that rather than being a symptom of overindulgence, gout is caused by a complex interaction between genetic and environmental factors.

“There is a lot of stigma around gout, but we now think the biggest reason some people don’t excrete uric acid properly is genetic,” says Stamp.

Men are three times more likely than women to suffer from gout, and some ethnic groups – notably Maori and Pacific people – are particularly susceptible. Up to 15% of Maori and Pasifika men have gout, compared with fewer than 5% of Pakeha men.

Given our high rates of gout, it’s not surprising that New Zealand researchers are now trying to unravel the mysteries of the condition described by the ancient Greek physician Hippocrates as “the unwalkable disease”.

Among them are a group at the University of Otago, where a study is comparing the DNA of thousands of people – some with gout, some without – in a bid to identify the predisposing genetic factors. The study has already found that a variation on one particular gene doubles the risk of developing gout for Pakeha, but increases it more than five times for Maori and Pasifika.

Traditionally gout has been portrayed as a disease of fat old men with a fondness for rich food and port. But you don’t have to be fat or old to get gout. Former All Black Neemia Tialata was just 20 and in great shape when he was diagnosed.

In any case, the rich-food hypothesis is a myth. University of Otago PhD student Tanya Flynn hit the headlines in August when she published a paper suggesting that tomatoes raise uric acid levels in the blood and may be a trigger for gout. Flynn emphasises that you’ll only develop gout if you are genetically predisposed to it. “It doesn’t matter what you eat,” she says. “You’re not at risk unless you have that background genetic thing going on.”

Even the well-established triggers, red meat, seafood and alcohol, as well as the more recent additions to the watch list – tomatoes and sugary drinks – don’t affect all gout sufferers in the same way. Some people can eat seafood, for example, but not drink beer.

Flynn says that, anecdotally, tomatoes seem to be a particular problem for Maori and Pacific people.

“Someone from the Cook Islands told me that if you went there and asked if tomatoes trigger their gout, 100% of people would say yes.”

If foods that raise uric acid levels can exacerbate gout, it seems logical that foods that do the opposite (possibilities include vitamin C and tart cherry juice) could help treat it.

But Stamp published research in 2013 suggesting that taking vitamin C does not have a clinically significant effect on uric acid levels. She’s about to turn her attention to tart cherry juice with a preliminary study involving 50 people.

She’s open-minded about using complementary therapies to treat gout, but says they’re more likely to work in combination with conventional drug treatment.

“I don’t think we’re going to get to the point where we use a totally dietary intervention.”

Follow the Listener on Twitter or Facebook.

Latest

March of the Algorithms: Who’s at the wheel in the age of the machine?
102434 2019-02-16 00:00:00Z Tech

March of the Algorithms: Who’s at the wheel in the…

by Jenny Nicholls

Complacently relying on algorithms can lead us over a cliff – literally, in the case of car navigation systems.

Read more
IBM’s new quantum computer: The future of computing
102458 2019-02-16 00:00:00Z Tech

IBM’s new quantum computer: The future of computin…

by Peter Griffin

The Q System One, as IBM calls it, doesn’t look like any conventional computer and it certainly doesn’t act like one.

Read more
James Shaw: Capital gains tax key to fixing wealth gap
102456 2019-02-15 14:54:45Z Politics

James Shaw: Capital gains tax key to fixing wealth…

by RNZ

The week before a major tax report is released, Green Party co-leader James Shaw has again challenged his government partners to back the tax.

Read more
Jealousy, murder and lies: The killing of Arishma Chand
102448 2019-02-15 10:28:12Z Crime

Jealousy, murder and lies: The killing of Arishma…

by Anneke Smith

Arishma Chand was just 24 when she was murdered.

Read more
Top wine picks from Central Otago
102233 2019-02-15 00:00:00Z Wine

Top wine picks from Central Otago

by Michael Cooper

Tucked into small corners, Central Otago vineyards offer nuggets worth digging for. Wine critic Michael Coopers offers his top picks.

Read more
Ivanka and her tower of crumbs
102404 2019-02-14 10:33:12Z Arts

Ivanka and her tower of crumbs

by Preminda Jacob

For two hours each evening, an Ivanka Trump lookalike has been vacuuming a hot pink carpet at the Flashpoint Gallery in Washington, D.C.

Read more
Youth mental health is in crisis and NZ is failing to keep up
102393 2019-02-14 09:52:16Z Social issues

Youth mental health is in crisis and NZ is failing…

by The Listener

The introduction of a free youth mental-health pilot for Porirua, and later the wider region, is welcome news, but it's far too little, far too late.

Read more
Guyon Espiner: Year of delivery begins in defensive crouch
102387 2019-02-14 09:21:07Z Politics

Guyon Espiner: Year of delivery begins in defensiv…

by Guyon Espiner

For a government promising 'a year of delivery' it has begun in something of a defensive crouch.

Read more