HEALTH Could Santa have gout?

TUT TUT Father Christmas might have to reconsider his lifestyle if he’s to avoid joint pain.

Could Santa be at risk?


Health
Dr Ronan Clancy

’Tis the time to be merry and purge the coldest and darkest period of the year with rich food and drinks to warm the body and spirit.
Santa Claus certainly embodies this tradition. The stout little man with rosy cheeks, circumnavigates the globe delivering gifts to all children, his chronologically baffling one-night feat sustained with tipples of brandy, whiskey, milk and chocolate cookies…
However, both his diet and the contents of a fully laden Christmas table also represent what were once believed to be the primary causes of a painful and historically famous arthritis: Gout.
Gout affects the joints of the body causing attacks of pain, redness and swelling. The big toes are affected in more than 50 percent of cases. The condition impacts approximately 1 percent of the population, and it is more commonly seen in men and of advancing age.

Disease of kings
Once called ‘the disease of kings’, gout is historically associated with culinary and alcoholic over-indulgence, many famous figures (some paragons of civilisation, others less benevolent) suffered its fire.
The overweight, gluttonous Henry VIII (1491 to 1547) was often pictured holding a chunk of meat or goblet of wine (both of which increase the risk of gout). When he wasn’t beheading his wives, poor Henry was coping with attacks of gout and thus had an understandably short temper!
King Charles I of Spain (1500-1558), whose reign oversaw the conquistadors conquering the Aztec and Incan empires, was also a Royal who enjoyed the excesses of courtly life. Exuberant banquets and a four-handled wine tankard caused gout so bad it forced him to abdicate.
Benjamin Franklin, the 18th-century Renaissance man who discovered electricity, invented bifocals, and was a founding father of the United States, also suffered. He missed many of the meetings held to draft the Declaration of Independence. Fortunately, Thomas Jefferson sent the documents to Franklin, so he could draft his part into American history from the comfort of his own bed.
Genius mathematician and formulator of the irrefutable laws of motion and universal gravitation, Sir Isaac Newton, was yet another famous historical figure who also experienced gout.

Causes and symptoms
Thankfully nowadays, both the causes of the debilitating condition and its prevention are clearly understood.
In gout, the kidneys fail to efficiently eliminate a chemical called uric acid, formed from purines (present in the proteins of certain food types). Uric acid levels in the bloodstream begin to climb. At high levels over time, uric acid changes from a fluid state to one of solid crystals known as monosodium urate.
These crystals are slowly deposited in the joints, skin and kidneys, much like a pan of salty water, when slowly boiled to dryness, leaves a fine coating of salty residue.
Normally super smooth and lubricated, the internal surfaces of the joint become gritty as crystals accumulate. This causes friction and an immune system reaction called inflammation, which causes the classic redness, swelling and pain of acute gout. If this occurs over and over, irreversible damage and destruction of the joint occurs, leading to deformity, arthritis and pain – just as pouring sand into an engine would cause grinding, overheating and eventual breakdown. Crystals can also accumulate in the skin and kidneys as kidney stones.

Diagnosis and treatment
Diagnosis of gout is based on symptoms, blood uric acid levels and synovial fluid samples from the joint.
Acute attacks are treated with anti-inflammatory and sometimes steroid medications. Recommended lifestyle changes include weight loss, reduced alcohol intake and the avoidance of purine rich foods. Preventative medications to lower uric acid levels can also be prescribed by your GP.
On these cosy winter nights a blazing fire is a wonderful thing, but as blazing big toe is an entirely different matter! If you are worried you may be suffering from gout, contact a GP as soon as possible.
Wishing all readers a very happy Christmas!

Dr Ronan Clancy is a GP at the newly opened Clancy Medical Practice, James street, Westport (www.westportgp.ie). He is in practice with Sarah Kavanagh, chartered physiotherapist.