Why the wheelchair? Could it be gout?

When Paul Manafort appeared in court for sentencing recently, he was in a wheelchair and pleaded for leniency, in part because “his confinement had taken a toll on his physical and mental health.” He reportedly had symptoms of depression and anxiety — but what was the health problem that put him in a wheelchair? According to multiple news reports, the answer is gout. Yes, that ancient disease you may have thought didn’t exist anymore has stricken Mr. Manafort. He joins the rising number of people in the country diagnosed with this common disease.

What is gout?

Gout is a cause of severe joint pain and inflammation. This form of arthritis develops when crystals of uric acid (a normal byproduct of our body’s metabolism) deposit near joints and other parts of the body. Gout develops because the body makes too much uric acid, the kidneys don’t get rid of enough of it, or a combination of both.

For some, dietary factors — consuming foods and beverages that produce a lot of uric acid — seem to play an important role. For others, the problem may be one or more medications that cause the level of uric acid to rise. Genetic factors are also important; the way the body handles uric acid may vary based on the genes you inherit. The observation that gout sometimes runs in families supports a genetic contribution.

Some facts about gout

Gout is on the rise. According to the most recent estimates, nearly 4% of the adult population in US now has gout, while less than 3% had it 25 years ago. The increase is thought to be due to rising rates of obesity, use of certain medications, and the rising popularity of high-fructose corn syrup (as found in carbonated beverages and many other foods and drinks).

Men are more likely to get gout and can develop gout at any age, but women rarely get it before menopause.

Gout used to be called “The disease of kings.” This was supposedly because in ancient times, only those who were wealthy enough to consume a lot of alcohol, red meat, and organ meats (such as liver) tended to get gout. While Henry VIII reportedly had gout, it can no longer be considered the disease of kings. People of any socioeconomic status can have gout.

Diet may matter less than we thought. A new study analyzed dietary surveys, genetic analyses, and uric acid levels among more than 16,000 people in the US. They found that dietary choices accounted for less than 0.5% of the variation in uric acid, while genetic factors accounted for about 24%. Since gout is caused by high uric acid, this study suggests that genetics matter much more than diet when it comes to the risk of gout.

The good news

Among all forms of arthritis, gout is among the most preventable and treatable. Some of the best ways to avoid gout include maintaining a healthy weight, moderating alcohol consumption, and maintaining a healthy blood pressure.

And there are highly effective treatments. These include several medications (including corticosteroids, anti-inflammatory medications, and colchicine) to treat a sudden gout attack, and others (including allopurinol and febuxostat) that can prevent future attacks by lowering uric acid. In fact, treatments for gout are so good, it’s quite unusual that a person would be confined to a wheelchair despite proper treatment.

There may be more to gout than arthritis

While the sudden and severe arthritis of gout gets most of the attention, high blood uric acid may cause other problems. A kidney stone is another common (and terribly painful) complication. In addition, there is mounting evidence that high uric acid may contribute to high blood pressure, kidney disease, and cardiovascular disease, and that medications to lower uric acid may reduce the risk of these problems (although more research is needed to prove this).

The bottom line

Although gout can be temporarily debilitating, excellent treatments are available. So, while most of the news hasn’t been good for Paul Manafort lately, his gout should be just a temporary setback.

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