Gout and Out

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A medical risk factor many doctors ignore

The symptoms of his disease were excruciating and lasted up to weeks at a time, yet Victor Konshin had little choice but to endure them because the dozens of physicians he was consulting—like many others—mistakenly considered gout to be benign.

But the disease’s underlying cause, a buildup of uric acid known as hyperuricemia, was slowly killing him, said Konshin, a high-tech engineer who has studied more than 500 scientific research articles and texts on gout.

For years, Konshin suffered painful gout attacks, but following a particularly bad episode, he set out to learn all he could about gout and says what he learned was shocking. He has since written the book Beating Gout: A Sufferer’s Guide to Living Pain Free and is working to raising awareness of hyperuricemia.

“Hyperuricemia affects one in three Americans—even in those who don’t have gout, and it can be very dangerous” Konshin said.

“Hyperuricemia has been linked with many of the killers that plague us today including heart disease, liver disease, stroke, diabetes and it has even been identified as a major cause of obesity,” Konshin said “It is probably one of the most deadly, misunderstood and under-appreciated public health threats in the world today.”

“What’s worse is that most doctors are unaware of how dangerous hyperuricemia is.” Konshin continued. “Historically, it was thought that hyperuricemia was harmless, perhaps even beneficial, but recent research has shown that hyperuricemia is associated with serious diseases. Doctors often do not treat gout correctly and hyperuricemia at all.

“One study found that doctors made significant errors when treating gout patients 78 percent of the time. The seriousness of gout is often under appreciated by general practitioners. Uncontrolled gout may result in severe and permanent joint damage and large growths of uric acid crystals called tophi.”

Nasty side effects
Konshin says the typical treatment for gout includes prescribing a medication called colchicine, which is not very effective and has “nasty” side effects including severe nausea, diarrhea and vomiting and does not treat the underlying hyperuricemia.

“When doctors do give the right medications, they usually prescribe it at the wrong doses and that causes additional problems, such as an increase in gout attacks which causes patients to stop taking their medication,” he says.

Also, when doctors run blood work to check for hyperuricemia, Konshin says the lab results often aren’t accurate because the “normal” range is skewed. “When doctors get blood results back, the labs show a ‘normal range’ for uric acid levels. This normal range is calculated from the results of all the other patients tested. However, since so many people have high levels, that skews the normal range upward. Anything above a 6 mg/dL is too high, but lab results often come back showing levels as high as 8.5 mg/dL as being normal.”

Konshin suggests that people ask their doctors what their level is and that anyone whose uric acid level is above 6 mg/dL should ask their doctor regarding what action to take to lower their uric acid level.

Research shows about 90 percent of people with hyperuricemia have it because of a genetic condition, accrding to Konshin. “But some types of leukemia, kidney diseases and metabolic disease can cause hyperuricemia," he says. "Some of these can be fatal so your doctor needs to rule. Also some medications such as diuretics used to treat high blood pressure can increase uric acidity. So it is important for your doctor to see if any of these are present.”

One myth is that diet plays a key role in controlling hyperuricemia and gout, Konshin said, adding that the two conditions are only slightly influenced by diet. “Diet does have an affect, but it’s a much smaller role than most doctors think today,” he says. “Diet can trigger attacks, but you usually

cannot control gout or hyperuricemia by diet alone.”

Patient education is key to helping those who suffer from gout get the quality of care they need. "I am always struck by the horror stories I hear from people who are still having frequent and intense gout attacks,” Konshin says. “When I ask them a few questions about how they are managing their gout, it quickly becomes clear that no one has ever explained to them how to manage this disease, how to use gout medications properly or make even the simplest of lifestyle changes to avoid gout attacks.”

By raising awareness for gout and its underlying cause—hyperuricemia—Konshin hopes to save others from suffering needlessly. ”Gout has been recognized as a unique disease for all of recorded medical history and is now one of the most well understood diseases," he says. "Because of this, the medical community has lost interest and all but ignored it. This has made gout one of the most mismanaged diseases today. And now, research is beginning to show just how dangerous hyperuricemia is. This has resulted in renewed interest, but there is still far too little research going on.”

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