The bad news is that nearly 4 percent of the population, roughly 8.5 million people, have gout, and 20 percent have high uric acid levels in their blood, which predisposes them to it. Worse, said Paul Doghramji, a family physician in Collegeville, Pa., who has conducted research on gout, people who suffer from gout are more prone to heart attack, stroke, kidney damage, premature arthritis, diabetes and sleep apnea (the latter because many people with gout are also obese).
The severe pain that is almost always the first signal of an attack of gout occurs when the uric acid crystallizes in a joint. This happens in parts of the body where the temperature is lowest, so the big toe is most common, followed by the ankle and the knee. It's why you'll almost never see someone with gout in a hip or a shoulder, Doghramji said.
Its nickname, the disease of kings, comes from the long-held belief that a rich diet, affordable only by the wealthy, caused gout. That's not really true, but diet does play a big role for many people. Drinking beer and eating organ meats or foods with a lot of high-fructose corn syrup, or getting too little water, dairy or Vitamin C, can cause gout, according to Doghramji.
Other people just naturally have a problem removing uric acid from their blood.
A typical patient hobbles into Doghramji's office with one shoe off, complaining of pain so severe that he can think his toe is broken. It hurts so badly that some don't want the doctor to examine the toe. "They say 'Don’t look at , don’t touch it, don’t even point at it,' " Doghramji said. "It’s the most painful thing short of taking a hammer and smashing your toe."
There are a number of good medicines for treating gout, and in other countries, such as Japan, doctors will try to lower the concentration of uric acid in the blood to keep it from occurring. Those medications are not yet approved for use that way in the United States, Doghramji said, and once someone has an attack, there's a 75 percent chance he'll have another within a year. And as people live longer, primary care physicians are seeing more cases of gout because there is more time for uric acid to build up in the blood, he said. But gout remains the only inflammatory arthritic condition that's curable, Doghramji said.
So while you're pondering how Doran is going to deal with the treacherous Ellaria (among the other questions raised Sunday night), you can also research how you'd handle a gout flare-up here, at Doghramji's Web site, jointsaflame.com.