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Gout, the disease of kings, is on the rise again

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Indulging in foods such as shellfish may trigger an attack of gout. (Sarah Brown/CNS)

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Indulging in foods such as shellfish may trigger an attack of gout. (Sarah Brown/CNS)

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Maria Cicchino, 46, is one of a growing number of Americans suffering from gout. (Courtesy of Maria Cicchino)

It was a rare indulgence at her parents’ house: two dozen raw clams, a two-pound lobster drenched in butter and shrimp with linguine over the course of 18 hours. Within two days, the pain that had been bothering the bunion on Maria Cicchino’s left foot became unbearable. It felt like an exposed nerve, she said. She couldn’t bear the weight of a bed sheet on her foot. Her gout was back.

“If you’ve had a root canal, it’s just like you have one in your foot,” she said.

Cicchino, who lives in Morristown, N.J., had her first attack of gout months earlier while on vacation in Florida. The painful disease is often triggered by rich foods, like shellfish and organ meats. She said she had forgotten about the risk of gout after the first episode.

“I did it to myself,” she said.

Cicchino, 46, is one of a growing number of Americans afflicted by gout. Known as “the disease of kings,” gout calls to mind corpulent aristocratic men feasting on rich food and port. The disease has been well-documented since the time of the ancient Greek physician Hippocrates, but it seemed to disappear from public consciousness after Benjamin Franklin.

Gout is a form of arthritis caused by the accumulation of sodium urate crystals in the joints. The crystals form when there is a high level of uric acid in the body, often from the breakdown of energy-providing compounds called purines in foods. While a patient may have a high concentration of uric acid in the blood for a long time with no symptoms, rich foods and alcohol can trigger a painful attack of gout, most often in the big toe.

Today, the increase in obesity and more widespread use of certain medications have contributed to the prevalence of gout, experts say. At a trim 105 pounds, Cicchino looks for other explanations.

“We may be in the midst of the third great gout epidemic of Western civilization,” Dr. Gerald F. Falasca of Cooper University Hospital wrote in a 2006 article in the journal Clinics in Dermatology. The first two, during the Roman and British empires, were affected by rich diets--a factor present today--and exposure to lead, which is now rare.

Falasca, a rheumatologist in Camden, N.J., said in an interview that he saw one or two patients a week for gout in the spring and fall. He attributes the rise in gout to obesity and the increased use of diuretics to treat such conditions as high blood pressure, congestive heart failure and edema.

The beginning of a gouty attack may wake up the sufferer in the middle of the night. Aretaeus the Cappadocian, a second-century physician, wrote that “no other pain is more severe than this, not iron screws, nor cords, not the wound of a dagger, nor burning fire.”

With its link to diet, gout can flare up just after a day of indulgence or a seafood binge like Cicchino’s.

“We see a good deal of gout on Jan. 2 and July 5,” Falasca said. Cicchino admits she loves to eat--especially organ meats, seafood and other meat--but says she normally eats small portions and controls her diet. She does not drink alcohol, she said.

High-protein, low-carbohydrate diets have contributed to the rise in gout, according to Joan McTigue, a member of the board of directors for the Gout & Uric Acid Education Society. The nonprofit group of health care professionals was founded about a year ago to inform the public about gout by dispelling such myths as the belief that it only afflicts older, heavy men, she said.

A variety of factors contribute to the disease, including family history, other diseases, medications and lifestyle.

In the past, gout was a disease of the affluent, who could afford the purine-rich foods that contribute to uric acid buildup. King Henry VIII, famous for gluttony and decadence, suffered from gout. Benjamin Franklin wrote a dialogue between himself and Madam Gout one midnight, asking, “What have I done to merit these cruel sufferings?”

While regal associations go back to the king of the dinosaurs--a 1997 article in the journal Nature suggests a tyrannosaurus rex suffered from gout--today the disease affects all social strata. A study published in 2004, one of the more recent on the subject, found that the overall prevalence of gout or its precursor hyperuricemia increased 80 percent from 1990 to 1999 among a managed care population in the United States.

Cicchino has her own theory for why gout is no longer an affliction of the old and indulgent. Exposure to lead was a large factor in previous waves of gout; she thinks other metals and toxins may be contributing to its rise today. She said the presence of mercury and other toxins in seafood worries her the most.

“Any kind of fish, I don’t want to look at it,” she said. She is carefully watching her diet to prevent any more attacks. “That was my last one, and I plan not to have any more,” she said.

E-mail: ssb2130@columbia.edu