Gout, sex and the city

GOUT is a disease that affects joints and it causes acute pain and inflammation in joints. Any joint can be affected, but classically the big toe is affected particularly at the beginning of illness.

Gout is caused by excess uric acid which is a waste product of the body after breaking down cells and food. Excess uric acid is usually excreted by the kidneys and some people under-excrete uric acid. This is the most common cause of gout. Other causes include kidney failure, drugs, and conditions associated with rapid cell break down such as cancer.

Hippocrates, around 400 BC, was the first known physician to attempt to describe gout in detail. Some of his observations such as, “A woman does not take the gout, unless her menses be stopped” still stands today.

Nicknamed the ‘Disease of Kings’, throughout history gout has been associated with rich foods and excessive alcohol consumption. Claudius Galen, a physician to five Roman Emperors in the 2nd century AD thought gout was caused by too much eating and drinking and too much sexual activity.

In some eras gout was perceived as socially desirable because of its prevalence among the politically and socially powerful. Revealing your gout status could earn you a place at the high table. This perception continued in Europe well into the 20^th century. In the London Times in 1900, there was an interesting article on gout, in particular the observation that “the common cold is well named – but the gout seems instantly to raise the patient’s social status”.

In Zimbabwe, at present, my hypothesis is that there is significantly more gout among ministers and members of parliament as compared to the general population.

Lobengula (1845–1894), son of Mzilikazi, was the second and last king of the Ndebele people in Zimbabwe. He lived a lavish lifestyle and it is said he weighed about 120kg. By the time he was in his 40s, his diet of traditional beer (brewed using millet) and beef had caused him to be obese, according to European visitors. He had about 20 wives but this number is dwarfed by about 200 wives his father had.

Lobengula’s struggles with the disease are well documented by European settlers and he was treated by Dr Leander Starr Jameson, a British doctor.

It is not known how many Kings of Africa had gout. Many kings in Europe had the disease. French Royalty, King Louis XIV, his father and grandfather had gout. British Kings include King George III, his four sons and one daughter.

In the beginning women were left out in the gout gravy train. The fact that women can also develop gout was first recognised during the reign of Nero (AD 54–68) by Seneca who wrote, “in this age, women rival men in every kind of lasciviousness (expressing a strong desire for sexual activity) … why need we then be surprised at seeing so many of the female sex afflicted with the gout?”

Gout is rare in young women who are still having menstrual cycles. After menopause, the prevalence of gout in women approaches that of men.

Unfortunately, it is no longer fashionable to reveal your gout status. Like the common cold, everyone can have it.

In Punch, a London weekly magazine, there was an interesting observation in 1964 which reads, “In keeping with the spirit of more democratic times, gout is becoming less upper-class and is now open to all … It is ridiculous that a man should be barred from enjoying gout because he went to the wrong school.”

Gout is now free for all and in Europe it is increasingly becoming a disease of the less privileged. Cheap food and cheap alcohol has become a democratic right for all citizens.

Until recently, gout was uncommon in Zimbabwe, so was obesity. Professor Michael Gelfand, one of pre-independence Zimbabwe’s most distinguished medical practitioners, reported in 1969 that he had only seen six patients with gout among the indigenous Zimbabweans (then Rhodesians) over a six-year period.

In 1968, Kibukamusoke reported seeing six cases of gout over a seven-year period in Uganda and six were from a privileged background. In Africa, gout is still a disease of the privileged i.e. those people who can afford to buy plenty of food (especially meat) and have alcohol in abundance. Today gout remains uncommon in rural Africa.

There are many places in Zimbabwe which I consider a breeding ground for gout. For example, in Harare there is a place called ‘kwaMereki’. Barbeques (gochi-gochi) and an endless supply of beer is the order of the day. Such places are popular with Harareans. There is no better concoction for increasing your risk of getting gout than red meat and beer.

Unfortunately, having gout is no longer fashionable. It is associated with hypertension, obesity, high cholesterol and diabetes. These diseases constitute the metabolic syndrome which is associated with an increase in mortality from heart attack and stroke. It is not known how King Lobengula died and whether he had these other conditions associated with gout.

The association of gout and obesity has been recognised for centuries. William Cullen (1710 -1790), an Edinburgh physician, wrote, “The gout attacks men of especially robust and large bodies, men of large heads … especially men whose fathers had suffered”.

We are living in an era of an obesity epidemic. If not treated, gout crystals can be deposited in kidneys and this can lead to kidney failure. I have seen a lot of severely damaged joints due to gout. The uric acid crystals can be deposited under the skin and cause unsightly lumps (tophi).

The goals of treatment include terminating attacks, providing control of pain and inflammation and preventing future attacks. Your doctor can prescribe drugs such as colchicine and ibuprofen to terminate an acute attack. After the acute attack, your doctor will prescribe drugs such as allopurinol and febuxostat to lower the uric acid levels and prevent future attacks and complications.

It is important that other associated issues of obesity, high blood pressure and diabetes are addressed if present. Your health is your priority, so take care of yourself.