News is Out About Gout

Although more than two million people in the United States currently have gout, an astonishing 40 percent of the general public doesn't even realize gout is one of the most painful forms of arthritis, let alone that it's the most common type of inflammatory arthritis in men older than 40, according to the newly formed Gout & Uric Acid Education Society (www.gouteducation.org). They have partnered with the Arthritis Foundation (www.arthritis.org) with hopes of changing that statistic by raising awareness today during the first-ever National Gout Awareness Day.

Gout is caused by an accumulation of uric acid in the joints. The excess uric acid (called hyperuricemia) can come from overeating foods high in purines – during digestion, purines are broken down into uric acid that your body either cannot excrete fast enough, or your body may make too much uric acid. But the condition, which causes burning, stabbing pain and swelling, can be tamed. "Hyperuricemia can be managed and controlled with medication and through adjustments to diet and lifestyle," says N. Lawrence Edwards, MD, chairman and CEO of the Gout & Uric Acid Education Society and Professor and Vice-Chair of the Department of Medicine at the University of Florida in Gainesville. "We formed the Gout & Uric Acid Education Society to educate the public and the health care community about gout and the related health care consequences of high uric acid levels, with the aim of improving the quality of care and minimizing the burden of gout," he says.

Dr. Edwards is the expert who reviews the gout information in Arthritis Today's annual Drug Guide (www.arthritis.org/ArthritisToday). I've had the opportunity to discuss gout with him over the past several years, as we've updated the information in the Drug Guide. We're still waiting to see whether the new gout drug febuxostat will be approved by the FDA, but in the meantime, gout can be controlled by allopurinol (Lopurin, Zyloprim), if your body produces too much uric acid, or by probenecid (Benemid, Probalan), if you don't excrete uric acid fast enough. Colchicine can be prescribed to help reduce the pain and inflammation of gout attacks, too, as can NSAIDs or corticosteroids.

If you have gout, though, you can't just take the uric acid-controlling medication when an attack occurs – the medication must be taken for life to keep uric acid levels in balance. You must also follow the diet recommended by your doctor to keep uric acid levels from getting too high. Rich foods and beer aren't the only culprits in gout attacks; sometimes perfectly healthy foods such as certain types of fish or vegetables can be high in purines and raise uric acid levels. Exercise also helps reduce gout attacks by improving circulation and metabolism, to help the body remove uric acid, and getting body weight into a normal range – obesity quadruples the risk of developing gout. And having gout means more than the ocassional painful attack. The uric acid crystals depositing joints can lead to destruction of joints, along with kidney problems.

Also important, especially in these summer months, is staying well hydrated by drinking water. (Look for news on water's role in decreasing gout attacks in the July-August issue of Arthritis Today.)

In the November-December 2005 issue of Arthritis Today, we reported that gout is not just a disease of men who overindulge. Women get gout, too, although usually after menopause. When estrogen levels decline, uric acid levels increase, but it takes several years until the levels increase to the point where crystals form. From 40 to 60, more men than women have gout. Around age 60, men and women are about even, as far as gout is concerned. But after age 80, more women than men have it.

If you already have a form of arthritis, such as osteoarthritis (OA), rheumatoid arthritis (RA), ankylosing spondylitis, psoriatic arthritis, or one of 100 other types, you may still develop gout. Although you might not be able to tell whether the joint pain and swelling you experience is caused by a new case of gout or your existing arthritis, your doctor can by doing a blood test to measure your uric acid levels and by examining your joints. To read about one man's quest to find out the cause of the pain in his feet and knees, go to www.arthritis.org/arthritistoday/oncall/archives/qa/oncall-gout.asp. And if you have any questions about gout, feel free to e-mail them to me directly at www.arthritis.org. I'll try to get them answered as we prepare for the second annual National Gout Awareness Day in 2008.

So Far, So Good... part 2

Well, what do you know? The combo of a good-for-you, high-fiber cereal, blueberries and organic skim milk really does make my blood sugar spike! My nutritionist needs my readings on Monday mornings; here is what I sent her earlier today – a record of the last few days of my life:

5/17/07: walked at 7:15 am and 2:20 pm
FBG = 97
2-hour post breakfast = 116
2-hour post lunch = 96
2-hour post dinner = sorry, didn’t have dinner til 9 and fell asleep at 10:30.

5/18/07: walked at 7:00 am and 3:20 pm
FBG = 112
2-hour post breakfast = 109
2-hour post lunch = 161! (had lunch at son’s gifted program presentation/party — ate very light there, since choices weren’t great and then had bowl of really healthy cereal with organic skim milk at home)
2-hour post dinner = 122

5/19/07: Shopping, housecleaning and laundry were activities during day; dinner and play with my mom at night
FBG = 94
2-hour post breakfast = sorry, forgot — I was out shopping/running errands
2-hour post lunch = 119 (had turkey, 1 slice cheese, lettuce and light mayo in a no-carb wrap along with 1 cup of leftover ravioli)
2-hour post dinner = 130 (had brown rice, chicken and veggie stir-fry with unsweetened iced green tea -- something in the soy sauce?)

5/20/07: walked in pool 30 minutes, walked at night 25 minutes
FBG = 92
2-hour post breakfast = 102
2-hour post lunch = 146 (had cereal with blueberries and organic skim milk)
2-hour post dinner = 150 (had hot dog, pasta/veggie salad made with whole wheat pasta and no-carb Italian salad dressing, 1-cup mix of red grapes/cherries and orange slices, 1/2 cup sugar-free ice cream)

5/21/07:
FBG = 91
2-hour post breakfast = 157! (had 2 eggs, half slice of cheese on whole wheat English muffin and no more than 2 ounces of OJ)

I’m feeling fine and committed to doing this — I’m just totally surprised that small amount of OJ or the cereal/fruit/milk combo, which seems so healthy, would have such an effect. Wow!

I have to say, though, that really watching everything I eat and making sure I get a good amount of activity has me feeling much better. I think the inflammation has gone down somewhat – my hands and ankles are less puffy, my fingers less stiff and my wrists less sore – and I am definitely less tired than last week. I was having trouble keeping my eyes open while driving to or from work before I started monitoring my blood glucose levels. If they were too high, that would explain the fatigue. So, now, did my fatigue and inflammation come from only the gestational diabetes, meaning that my RA really is better during pregnancy? Or is it a combination of both? I don't think there's any way to tell for sure, but I'm sticking with what's working!

So Far, So Good... part 1

I know it's been only one day, but I have lived strictly by the rules today, and my blood glucose levels have been right on target. I feel good, so I want to share what I've done, in case you want to try it, too:

6:45 a.m. -- Fasting blood glucose of 97 (80 to 95 is normal, so just a tick or two too high); had big glass of water
7:10 a.m. -- Walked 1.5 miles in 25 minutes – not fast, considering I'm waddling right now at 7 months pregnant, but it's not too slow to be ineffective, either.
8:15 a.m -- Breakfast: 2 scrambled eggs, 1 piece cheese and 1 piece whole wheat toast
Tea (no sugar) in car on way to work; finished at desk
10:30 a.m. -- 2-hour post-breakfast glucose level of 116 (should be less than 120, so off to a good start)
12:30 p.m. -- Lunch: leftover chicken breast, brown rice and peas from last night's dinner; 4 ounces unsweetened applesauce and a 4-ounce yogurt; more tea (unsweetened green with chamomile)
2:20 p.m. -- Walked 6 city blocks in 20 minutes (again, not high intensity, but not strolling either)
2:40 p.m. -- 2-hour post-lunch glucose level of 96 (well under 120!)
3:15 p.m. -- enjoying my apple and peanut butter along with water while I'm working.

Doing well! More later...

Inflammation is Taking Over

I had an interesting lunch-time appointment with a nutritionist today. Beyond the obvious cruelty in meeting with a nutritionist when you're hungry, I was concerned to find out that along with having to deal with RA and autoimmune thyroid disease while pregnant, I now have gestational diabetes, too. I never had that with any of my three other pregnancies, but both my parents have diabetes, and next week I turn 41 – my risk of developing diabetes is going up, so I'm not totally surprised. What did surprise me was how quickly I went from normal checks for sugar to failing the one-hour and then three-hour glucose tests.

The root of it all? Inflammation. Over the past few weeks, my sed rate and CRP level have gone up. Now that I'm off sulfasalazine for the RA, the inflammation is increasing. I've been reading for quite some time about the connections between inflammation and diabetes, and I'm currently working on an article about it. How ironic.

So how to go about resolving the problems? Fix the timing of when I eat, and of course, eat less, move more and try to relax. Overall, I already eat the way the nutritionist recommends. I don't drink fruit juice or sodas very often – certainly not every day, sometimes not even weekly. And my family doesn't have a dessert-every-night-after-dinner habit, so no problem there. My favorite snack? Apple slices and peanut butter – one she recommended. My usual lunch? Dinner leftovers (so meat and veggies) or soup and a sandwich – both on the list. But this one surprised me: My usual breakfast of high-fiber cereal, fruit and organic skim milk is better eaten in the middle of the day. Who knew?

Apparently the hormones generated by the placenta during pregnancy cause insulin to spike both in the morning and at night (and I do admit to the ocassional bowl of cereal before bed). So, for breakfast she recommended scrambled egg and whole wheat toast. I can do that, although one of our upcoming nutrition articles points out that eggs might not be the best choice for people with diabetes. (Find out why in the Sept-Oct issue). I'll try alternating eggs with organic, whole-grain, steel-cut oatmeal and see which affects my glucose level more. I'll now be testing my blood glucose four times a day and reporting my results weekly to the perinatologist.

Beyond that, I'll continue walking – maybe go for two walks a day. The pools are open here now, so I'm back to walking in the water and doing laps, which I love. My oldest son goes with me to the gym ocassionally, and we do the cardio and weight machines together (usually while laughing, which is good for reducing inflammation, too). School's out next week and baseball season winds down in early June, so we can do that more often. I'm still taking a few flights of stairs at work and elsewhere this far along in the pregnancy (beginning of third trimester) so staying active won't be a problem. Finding time to relax, though? Hmm. Does collapsing into bed at night after a jam-packed busy day count?

I've got to do it all, though. For myself, for the little girl I'm carrying and for all of you – to prove that it is possible to take control of the inflammation that can affect every system in our bodies.

I'll be continuing to work on the inflammation and diabetes article for the next few weeks. Post a comment here if you also deal with both conditions and let me know what works for you. If you'd like me to consider including a comment from you in the upcoming article, e-mail me directly at dsiegfried@arthritis.org.

Take care!