NewsWorldDiego Benavent, rheumatologist: "Gout patients are increasing, in part...

Diego Benavent, rheumatologist: “Gout patients are increasing, in part due to aging and obesity”

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Obesity, diabetes and population aging are behind the increase in the prevalence of gout in SpainGout is a type of arthritis characterized by the accumulation of uric acid crystals in the jointsDiet and medication are key to controlling acid levels uric acid in the body and not suffer painful attacksIn the collective imagination, gout is a disease linked to obesity, shellfish, eating red meat. But the ailment goes far beyond that, it is directly linked to aging, current lifestyle and diet and it is not just the swelling of the foot that we all have in our memory. Gout is a type of arthritis characterized by the accumulation of uric acid in the form of crystals in a joint. In moments of acute attacks it produces a lot of pain, and it is incapacitating. Its incidence has been growing steadily since the 1990s, and currently the prevalence of gout disease in Spain is 2.4% of the adult population, which is equivalent to approximately 800,000 affected in our country. According to the results of the EPISER 2016 study carried out by the Spanish Society of Rheumatology (SER), 66.6% of patients are over 60 years of age, and of these, 83% of hospitalized gouty patients were male, with an average aged 72 years and a significant burden of comorbidity. Diego Benavent, from the Rheumatology Service of the La Paz University Hospital in Madrid, delves into the causes of this increase in this interview.Question. Since when and why are there more diagnoses of gout? Answer. The increased prevalence of gout has been described since the beginning of this century. Many causes influence this: It is diagnosed more. There is more awareness. Years ago it was underdiagnosed. But there are also direct causes that, apart from detecting more, there is really more: More longevity. It is associated with adults and the elderly. Other pathologies that have increased in recent decades and are directly related to gout, such as metabolic syndrome, obesity, diabetes… In turn, the high consumption of certain drugs and red meat favor the onset of the disease. All of this increases uric acid in the body, and this is what causes gout, its accumulation in the form of crystals. P. Can a more sedentary lifestyle favor it? A. It is probably not a direct cause, but a more sedentary lifestyle is a determining factor in obesity or metabolic syndrome, which, as I say, are directly related to gout. That is why in the approach to gout, the re-education of the patient’s habits is proposed. Q. Do specialists fear that with the pandemic, and the increase in overweight in the population, the prevalence of gout will also increase? Disease diagnoses in more recent years are still being analyzed to determine the effect of the pandemic on gout. What has been shown is that in periods of ten years, from 2005 to 2015, hospitalizations of patients with gout have increased. A report revealed, specifically, that the hospitalization rates of people with gout were increasing progressively, going from 35 cases per 10,000 inhabitants per year to 50 cases per 10,000 inhabitants/year. Beyond the stereotype of a gout attack with a swollen foot, what risks and effects does gout have on health? Gout is known for podagra attacks, which affect the joints of the foot or toes and lead to acute and painful inflammatory episodes or attacks. The inflammation is caused by an excess of uric acid that forms small crystals in and around the joints. But gout can affect other organs and systems, because uric acid can create deposits in the kidney, accumulate in the skin… And also in other joints of the body. Patients can have arthritis in all the joints of the body: it is they are hot, red, painful. And they limit the mobility of patients. In addition, if gout is not treated long-term, preventing the accumulation of uric acid, deformations can occur. Another example: if it accumulates in the skin, uric acid crystals are deposited under the skin and produce subcutaneous deformity. Q. Regarding hospitalizations, why has this increase occurred? Patients with other diseases (with comorbidities) who have gout must be differentiated from those admitted for gout. Both have increased in recent years. The latter go to the hospital because they are suffering from an inflammation that makes them unable to walk, that hurts… and they are hospitalized because it is important to rule out that this suffering is not caused by other pathologies such as infections, and to treat the joint inflammation. Patients who are admitted for another reason and gout ends up being added to their diagnosis are normally older patients with multiple pathologies. And from this profile there is also more income because the population is aging, fundamentally. In any case, it should be noted that gout is not usually managed in the hospital, but in the mildest cases it is managed in primary care. It is acute attacks of gout that may need hospital care, but these usually go away within four to seven days. But that does not mean that the person is cured, because if he has high levels of uric acid in the blood, he will have new outbreaks or relapses. So when the attack is over for a while, a treatment must be introduced to lower uric acid levels. This is a long-term treatment. Q. Regarding life habits, are gouty patients re-educated? A. Yes, it is established by all the guidelines on the disease. The purine-restricted diet, which was done before, can help reduce uric acid levels, but not as much as drugs. So now we focus more on re-educating patients by limiting the intake of red meat, promoting skimmed dairy or vegetables, because although some have been reviled, it has recently been shown that they help eliminate uric acid even though some are rich in purines.

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