Nutrition Frenzy

But rich diet is only one factor in rising rates of ‘the disease of kings’

Courtesy of JoNel Aleccia: Dr. Stephen Vogel should know better than to put chopped chicken livers on his Thanksgiving menu.

As a veteran victim of five years of gout attacks, the retired Gainesville, Fla., surgeon can more or less count on an excruciating flare-up of the acute arthritis that afflicts him and at least 3 million other people in the United States.

But does that mean he’ll steer clear of the savory spread at his brother’s house on Thanksgiving? Not a chance, said Vogel, 69, who is a walking, talking, noshing example of why rates of gout have doubled in the U.S. in recent years.

Indeed, gout has become the most common form of inflammatory arthritis in men older than 40, and increasingly common in women after menopause, said Dr. John Sundy, director of rheumatology and allergy research at Duke University.

Most long-term treatment of the disorder has relied on a drug developed in the 1960s, but on Monday, an advisory committee of the federal Food and Drug Administration recommended U.S. approval of the first new treatment to manage gout in four decades.

It’s not clear exactly how common gout is. A 10-year study of more than 4 million managed care patients in 1999 detected gout in 41 of every 1,000 people older than 75, up from 21 in 1,000 in 1990, according to the Journal of Rheumatology. Rates were more than 31 in 1,000 for people 65 to 74. Current rates have not been pegged, especially in younger people, because recent large studies have not been conducted.

At least one emergency department in Connecticut is keeping track on a small scale, however. At Windham Hospital in Willimantic, Conn., gout diagnoses appear to be up 23 percent over last year, according to Dr. Gregory Shangold, the ED director.

Gout is triggered by high levels of uric acid in the blood, a condition that occurs either when too much of the waste product is produced by eating certain foods, or too little is excreted by the kidneys. In either case, it accumulates, creating concentrations of needlelike uric acid crystals that pile up in the spaces between the joints.

Uric acid typically builds up over time, usually decades. While a single lavish meal isn’t enough to create conditions for gout, a flare can be sparked by a bout of binge drinking, by sudden dehydration or other changes in kidney function, or by trauma such as surgery or a heart attack. In some cases, a stubbed toe on the way to the bathroom in the middle of the night has been enough to send a susceptible patient into an attack.

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