29 March 2020
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Do you suffer from giddy giddy gout?

Dr Ross Walker
2 March 2020

The stereotypic image of a person with gout is the overweight middle-aged male who indulges in rich food and consumes too much alcohol. Although this may certainly be an example of someone with gout, it is far too simplistic and inaccurate.

Gout is, in fact, an inherited metabolic disease related to insulin resistance. Why is this important? It is important because insulin resistance is the commonest genetic abnormality in the world, affecting 30% of Caucasians, 50% of Asians and close to 100% of people with darker skin.

Insulin resistance is manifested as the combination of tendency to type two diabetes, hypertension, cholesterol abnormalities, where the triglycerides are high and the so-called good cholesterol, HDL is low, along with abdominal obesity and tendency to cardiovascular disease. Two other common metabolic associations with insulin resistance are fatty liver and gout.

There are some rare genetic metabolic causes other than insulin resistance that are not really relevant to this discussion.

Gout typically manifests as acute, very painful arthritis of the big toe but, in reality, can affect any of the major joints in the body. Although the last thing you want to experience is painful arthritis, gout has other associations and as with all other medical conditions, the best treatment of gout is prevention. The basic metabolic abnormality is an elevated uric acid. The crystals of uric acid precipitate in the joint leading to the painful arthritis. But these crystals can also affect the kidney leading to varying degrees of kidney impairment and hypertension.

There are very effective treatments to settle down an acute episode but there is also a drug that has been available for many years, which in most cases is very safe — Allopurinol. Taking Allopurinol in increasing doses to a maintenance of 300mg daily, once the acute episode has settled, should prevent gout in most cases with minimal, if any, side-effects. This will not only prevent further episodes of gout but will also protect the kidney from damage and help reduce blood pressure.

Interestingly, a recent large study of just under 24,000 people with hypertension showed that the commonly prescribed blood pressure pill, amlodipine, when compared with a diuretic or another commonly prescribed group of blood pressure drugs, ACE inhibitors, lowers the risk for gout by around 35%. So if you have unfortunately experienced gout in your life and also have hypertension, it is worth discussing with your doctor the preventive management for gout but also taking the appropriate therapy for your blood pressure.

Patients I manage with any chronic conditions are those who follow the appropriate lifestyle and are compliant with the prescribed medications and supplements. It’s not rocket science!

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