According to the National Institutes of Health, the prevalence of gout has increased in the last 20 years. In regions like New York City, gout appears increasingly in both older and younger people. The increase in the number of young people may be related to excess weight and dietary issues like diets high in sodium.
This article delves into the rising incidence of gout and the need for home care agencies to develop a keen awareness of this growing public health issue.
What Is Gout?
According to the Arthritis Foundation, it is a common form of inflammatory arthritis that causes joint pain, swelling, and stiffness for roughly 9.2 million Americans. It is the most common type of inflammatory arthritis (Source: Mayo Clinic).
Gout can affect anyone and happens when there is a high level of blood uric acid, causing pin-shaped crystal deposits (crystalline) to form inside the joints and soft tissues. The formation of uric acid crystals triggers inflammation and excruciating pain during gout attacks.
What Causes Gout?
The build-up of uric acid in the blood can cause crystal deposits around the joints, triggering gout. This can be caused by:
- Diets loaded with red meat, organ meats, and fish
- Excessive alcohol consumption
- Sugary drinks or snacks high in fructose
- Treatments such as chemotherapy and radiation, commonly used for cancer, can lead to higher uric acid levels
Symptoms of Gout
Sudden and severe bouts of swelling, redness, and tenderness (pain or discomfort when touched) in the joints and soft tissues, most often in the hallux (big toe), define gout. Frequently beginning at night, attacks or flares usually last for a week or two before resolving themselves. If not properly controlled, however, gout can lead to chronic (long-term) gouty arthritis, which can cause permanent joint damage and loss of motion.
Symptoms of a gout attack include:
- Intense joint pain, usually affecting hallux, but can involve the ankles, knees, elbows, wrists, and fingers
- Joint discomfort that can last from several days to several weeks
- Inflamed joints that are easily irritated by touch
- Redness as the skin over the joint hardens and tightens
- Low-grade fever in response to inflammation
- A generalized sense of sickness, pain, or exhaustion (malaise)
The Rising Incidence of Gout
The rising incidence of gout can be attributed to lifestyle changes that contribute to higher uric acid levels in the blood. The main drivers are dietary changes, wider use of medications that can elevate uric acid levels, and an aging population.
Dietary Changes
Increased consumption of food high in purines (crystalline compounds) is directly linked to an increased risk of developing gout. Crystalline can build up in the joints and soft tissues and, when levels become too high, cause painful attacks. These foods include animal products like red meat, organ meat, and seafood.
Gout risk can also be raised by fructose-rich beverages. These consist of drinks sweetened with sugar, such as sodas and fruit juices. Artificial or manmade sweeteners (e.g., high fructose corn syrup) are a major culprit of crystal buildup around the joints.
Medication Use:
Drugs used in heart faulure and high blood pressure (diueretics), can trigger gout attacks in certain individuals. These medications increase the amount of urine the body produces, leading to a higher concentration of fluid in the body and, therefore, the risk of developing gout crystals.
Over-the-counter aspirin has also been associated with attacks. Small doses of aspirin can limit the body’s ability to remove uric acid, and increase the incidence of flares.
Aging Population:
Home care agencies must be aware that the rising presence of gout in older people is partly associated with an increased lifespan. As people live longer, the risk of acquiring the condition naturally increases. Kidney function decline is expected as people age. Uric acid deposits may develop in the body if the kidneys are unable to adequately filter it out.
Elderly people (those 65 and over) are also more likely to take diuretics (52.6 percent), like those commonly used for hypertension, than any other age-defined population group (Source: Agency for Healthcare Research and Quality). Diuretics can make the crystal formation more likely to occur.
In Closing
Gout is the most common cause of inflammatory joint disease in America. It is caused by a limited ability to eliminate uric acid from the body.
As the presence of gout continues to rise, home care agencies must anticipate an increasing number of patients with inflammatory arthritis. By implementing strategic campaigns and leveraging existing resources, providers can meaningfully impact the lives of patients with the disease.