Columns

"People wish their enemies dead, but I do not; I say give them the GOUT…!” —Mary Wortley Montagu (1689 – 1762), English writer. 

Gout, the affliction, is amply dealt with on the Internet. I recommend a service of the U.S. National Library of Medicine National Institutes of Health called MedlinePlus and www.Mayoclinic.com/health/gout . 

Gout, “…that devil’s curse…”, “that Patrician malady” has been manifest in the creations of literary and historical writers of ages. Even a little humor: “For that old enemy the gout Had taken him in toe!” In toe--, get it? (Lieutenant Luff – The poetical works of Thomas Hood.) “… that scourge of the human race robbed Catherine de Medici of her personal charms, racking her bones and sinews” (The Huguenots in France and America, Vol I. 1843.) 

The first known play concerning gout was Tragopodagra by Lucian in the 2nd century AD. The Gout and the Spider is a well known humorous tale originating in the 9th century, but appearing in several centuries. Encomium Moriae by Erasmus praised gout in 1509. Podagra Encomium by Cardanus of Pavia appeared in 1562 and praised the folly of gout. 

Today, gout stings and inflames in numerous genres. It plays a part in children’s fiction, adult mysteries, “how to” cope, history, and of course, biography and memoir. Fiction for young children includes Raising dragons, by Jerdine Nolen and Marsupial Sue by John Lithgow. Black bridge: a mystery of Venice, by Edward Sklepowich. / The Gout hater’s cookbook. / Galileo's gout: science in an age of endarkenment. / Perfect I’m not: Boomer on beer, brawls, backaches, and baseball, by David Wells. 

“The Honor of Gout by Philander Misiatrus,” which was Benjamin Franklin’s pen name, was an article written by him in 1699, decades before he developed gout himself. In 1732 he printed in his Philadelphia shop “The honour of the gout; or, a rational discourse, demonstrating that the gout is one of the greatest blessings which can befall mortal man; that all gentlemen who are weary of it, are their own enemies; that those practitioners who offer at the cure, are the vainest and most mischievous cheats in nature. By way of letter to an eminent citizen, wrote in the heat of a violent paroxysm, and now publish'd for the common good.” The Old Man’s Wish was to …govern my passion with an absolute sway, And grow wiser and better as my strength wears away, Without gout or stone, by a gentle decay. (H. Playford, 1685. Theater of Musick). I had read somewhere that males contract gout after puberty and females after menopause. I was thirty when I had a brief gouty experience. Brief, 

thanks to colchicine, which I understand, can be tricky. I had been dieting, concentrating on protein. It was years before I could face a piece of calf’s liver again. Predisposing factors are said to include lead poisoning, diuretic therapy, penicillin and insulin, overindulgence in food, surgical procedures, Down’s Syndrome, fatigue, arthritis, alcoholism and obesity. Now I’m in my eighties and have had two brief occurrences – I resist saying episodes – and am subject to one or two or three of those factors. Colchicine still works quickly. 

Gout is a metabolic disease marked by painful inflammation of the joints, deposits of urates in and around the joints, and usually an excessive amount of uric acid in the blood. Gout affects 2.1 million Americans each year. It 

does run in some families. Historically known as "the disease of kings" or "rich man's disease," gout has increased in frequency. The increase is believed to be due to such increasing risk factors in the population as metabolic syndrome, longer life expectancy, and changes in diet. Gourmet, anyone? Julia, Jacques? 

Characterized by a buildup in the blood of uric acid that forms needlelike crystals, gout is rare in younger women but occurs in about one in 20 postmenopausal women. It comes and goes and in early stages, mostly affects the feet. 

Gouty arthritis refers to a form of arthritis caused by deposits of needle-like crystals of uric acid. (The term arthritis refers to more than 100 types of different rheumatic diseases.) Gouty arthritis accounts for approximately 5% of all cases of arthritis. Gouty arthritis is one of the most painful rheumatic diseases. It usually strikes a single joint, most commonly the big toe. When the big toe is involved, gout is known as podagra. However, it can also affect the foot (instep/heel), knees, wrists, fingers, elbows. Gouty arthritis is rare in children and young adults. Men are more likely to develop gouty arthritis than women. 

Watcha gonna do? Drinking coffee lowers the risk of gout in older women. The American Journal of Clinical Nutrition (August 25, 2010) reports research by Boston University's School of Medicine in which Dr. Hyson Choy demonstrated that drinking coffee lowers risk of gouty arthritis for men. Choi and his colleagues wanted to see if the same held true in women, especially older women who, after menopause, lose the uric-acid clearing benefits of estrogen. They contend that a few cups of coffee every day over many years cuts the risk of gout in postmenopausal women in half. 

After statistically controlling for other gout risk factors such as body-fat mass, alcohol consumption, use of diuretics and dairy intake, they found that a lifetime of drinking coffee appeared to make a significant difference in the risk of a first attack of gout. "The higher the consumption level, the lower the risk." What about coffee staves off gout is still not clear. And not everybody can tolerate it. Not only can caffeine raise blood pressure and leach calcium, upping the risk of osteoporosis, Choy’s research spoke only to a benefit in long-term consumption. 

More and more Americans are struggling with gout as rates of the painful and sometimes disabling arthritic condition continue a decades-long upswing, a new study shows. (HealthDay News) Researchers report that by 2008, an estimated 8.3 million Americans were subject to gout attacks, equivalent to 3.9 percent of the U.S. adult population, a substantial rise from the 2.7 percent prevalence rate noted in the late 1980s to early 1990s. 

The condition known as pseudogout (also called CPPD) can sometimes be confused with gouty arthritis because it produces similar symptoms. However, in CPPD, deposits are made up of calcium phosphate crystals, not uric acid. 

LOCAL & INTERNATIONAL NEWS 

Further to my November 17th column, an old (as in aged as well as in many years, dating back to when we were seated next to each other in our 12th grade homeroom) friend sends me a hardcopy of the December 2010 issue of “Whistle-stop EXPRESS,” which declares itself The leading information resource for Marin’s Active Aging Movement. And its 16 pages are impressive. TheWhistlestop.org. 

OWL (Older Women’s League: The Voice of Midlife and Older Women) is disappointed that the National Commission on Fiscal Responsibility and Reform included Social Security in its agenda. Social Security is not a part of the deficit facing our nation today. 

This is the second consecutive year that Social Security beneficiaries did not receive a COLA (cost-of-living adjustment). The Consumer Price Index in Social Security (CPI-W), which measures the rate of inflation, does not accurately reflect the rate of inflation faced by seniors who spend a huge amount of their income on health care.