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Photographer finds unwanted pain in the picture

When Scott Henderson learns he has the “disease of kings,” a doctor helps him get this increasingly common problem under control

Scott Henderson
Medication has helped Scott Henderson control his gout. Before he started taking it, he had to use crutches during flareups because of how badly his affected joints hurt. Photo by Sarah Pack
Helen Adams | adamshel@musc.edu | August 27, 2018

The “disease of kings” has spread to the masses, and people across the Lowcountry are feeling the pain. Gout, an extremely painful form of inflammatory arthritis, hit Mount Pleasant resident Scott Henderson right after Hurricane Matthew swept through in 2016.

“I spent a day cleaning up tree branches in my yard and a day volunteering to clean up the school by where we are. That second day, my knees really started to hurt.”
 
He thought it was from all the yard work. When the pain persisted, he saw a doctor who thought he needed knee surgery.
 
But Henderson wasn’t quite ready for that. He told the doctor he’d had painful, swollen feet and ankles in the past – so painful that he’d had a hard time functioning. “I had to use crutches to get around. I couldn’t put weight on my foot.”
 
Henderson, a part-time photographer and full-time neuroscience research program manager, suspected gout was in the picture. A test suggested he was right. The surgery was off, and an appointment with MUSC Health rheumatologist Richard Silver was on. 
 
Dr. Richard Silver 
Dr. Richard Silver 
Silver confirmed the diagnosis of gout by testing the knee joint fluid for urate crystals. He specializes in treating gout and other joint problems, along with issues involving muscles, ligaments and systemic connective tissues. He directs the Division of Rheumatology and Immunology at the Medical University of South Carolina.
 
He said Henderson had a classic case of gout, starting in the foot and traveling to other joints. Henderson is far from alone. The condition historically associated with the rich and famous, people such as kings who could afford luxurious food and drinks, now hits people from all walks of life because it’s so much easier to get the tasty things that can lead to gout. 
 
People are also heavier. “Gout is increasing in prevalence in part because the metabolic syndrome is increasing in prevalence,” Silver said. Metabolic syndrome means you have three or more of the following problems:
  • Waist size of 40 inches or more for men, 35 inches or more for women.
  • High blood pressure.
  • High triglyceride level.
  • Low “good” cholesterol.
  • High blood sugar.
Those factors can raise your uric acid levels, Silver said. “Uric acid is part of a breakdown of natural chemicals called purines that are building blocks for DNA. They’re absolutely essential. When purines are broken down, which is part of life, the end product is uric acid.”
 
Normally, the body gets rid of that uric acid, mostly through the kidneys. But when too much uric acid is being made or not enough is being processed out, it can build up and cause crystals to form in the joints. “People say it’s excruciatingly painful,” Silver said of gout attacks. “The pain has been compared to having a kidney stone.”
 
More than 8 million Americans suffer from gout. “In men, gout usually begins between the 30s and 60s. In women, it has a later onset, usually after menopause,” Silver said. That’s because when women lose estrogen, their uric acid levels start to go up.
 
creature with sharp teeth bites a person's big toe

While gout is on the rise these days, it's been around for centuries. This 1799 illustration by James Gillray shows the extreme pain gout can cause, often starting in the big toe.
Henderson, who rides his bike from Mount Pleasant to downtown Charleston for work and is not overweight, was surprised to find himself among those Americans. “A lot of it is diet-related, and you don’t think of yourself as eating all meat or eating poorly, which I still don’t think of myself as doing. But heavier meats and some kinds of seafood kind of predispose you to gout.”
 
Gout can also run in families, thanks to genes that control levels of uric acid.
 
Gout attacks can be triggered by:
  • Alcohol
  • Too much protein-rich food
  • Stress
  • Tiredness
  • Illness
  • Minor surgery
Silver said his patients want to know what they can and can’t eat. “If you put somebody on a low-purine diet, it’s not really compatible with a decent life. It’s some vegetables, no meat, no shellfish, no alcohol. None of the good stuff we like. It would be fruitless to put somebody on that. I tell them to be moderate in their diet and alcohol intake and to take their medicines.”
 
Silver does tell patients to make some changes. “Cherry juice can help with an acute attack and dairy products can actually lower the uric acid.”
 
Medications for gout include colchicine, non-steroidal anti-inflammatory drugs (NSAIDs) and steroids to treat acute inflammation. Allopurinol and febuxostat can reduce the blood levels of uric acid. There are also several drugs that help the body get rid of uric acid. 
 
“Gout is a chronic condition that can destroy joints and damage bones and cartilage if left untreated,” Silver said. “The key to successful management is maintaining a normal level of uric acid, which entails some lifestyle modifications and long-term medical care.”
 
Henderson takes allopurinol every day. “It’s been very beneficial. For the first year you take allopurinol, it can increase the risk of having a flare-up, but it didn’t for me. My gout is well managed. It doesn’t stop me from doing anything. This is just part of the cards that I was dealt.”

Foods to eat and avoid on a low-purine diet (Medical News Today, July 26, 2018)

Foundation funds 25 rheumatology opportunities at MUSC (MUSC Catalyst News, April 3, 2017)

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