The Stigma of Gout
Gout was once known as “the disease of kings” or “the disease of the wealthy.” Some have even referred to it as the “lord of disease and disease of lords.” Back then, only royalty and the wealthy were affected by gout because they had easy access to trigger foods like red meat and alcohol.
Gout may sound like a medieval disease relegated to history to some; the name has an almost comical ring to it. Gout is a painful condition that is surprisingly common. We’re puzzled as to why no one is talking about gout.
In earlier times, the Greeks called the gouty toe Podagra, child of Dionysus (God of wine and Aphrodite (goddess of love). Romans use this symbolism to say that gout was caused by too much food, wine, and sex!
Another common misconception about gout was that it was a cure because it restricted pain to a single area of the body rather than multiple areas. This was during the 16th and 18th centuries in Europe when people believed that a person could only have one disease at a time. They had no idea that gout is associated with a wide range of complications!
So gout doesn’t exactly have the most demeaning history like saying leprosy. Nonetheless, it carried a negative connotation. The idea is that if you have gout, you caused it yourself. If you just changed your diet and lifestyle, you wouldn’t be in pain in the first place.
As the number of studies on gout grows, we’re learning that the disease can be passed down through families. So, no matter how strict your diet is, if you eat that one thing, you may experience an unexpected gout flare.
Most people have no idea they have gout until their doctor tells them. This is usually done by measuring your serum uric levels. A uric acid test is performed on your blood, and if it is above the normal range (7 mg/dL and above), you may have gout.
Gout is a Royal Pain
Gout is a common type of arthritis caused by hyperuricemia or a buildup of uric acid in the blood. The body produces uric acid during the metabolism of purines, which are abundant in certain foods such as beef and seafood.
Uric acid crystals (monosodium urate) can form in the joints if the uric acid level in the blood becomes too high. These needle-shaped crystals tend to accumulate in the big toe joint of gout patients, causing inflammation and severe pain.
How Widespread Is Gout?
According to estimates, 8.3 million Americans, or about 1 in every 25 adults, suffer from gout. Men are three times more likely than women to be affected. This means that gout is more common in the United States than in many other well-known conditions, such as psoriasis and rheumatoid arthritis.
Indeed, it affects a greater number of people than celiac disease, multiple sclerosis, and peanut allergies combined. So, why isn’t gout being discussed? Gout appears to be becoming more common; its prevalence more than doubled in the United States between the late 1970s and the mid-1990s.
Rising obesity rates are probably a contributing factor to this. This may be because obesity raises the risk of high blood pressure and some diuretics, which are used to treat hypertension, also raise the risk of gout.
Additionally, gout risk is increased by cardiovascular disease, which is itself increased by obesity. Gout is more prevalent in older adults, so the aging population will probably increase in cases.
The History of Stigma Around Gout Disease
The earliest disease that had stigma surrounding it was leprosy. It was believed to be a sexually transmitted disease and if a person had signs of it, they were shunned or cast out of society.
In Jewish culture, you couldn’t be a priest if you had a flat nose. It was seen as a sign of leprosy which indicated sexual contamination. And religious figures couldn’t be associated with that.
Later on, leprosy was replaced by syphilis. It started as a deadly disease that took over someone’s life in months but over time, it became a chronic illness that one lived with for the rest of their life.
Physical signs of the disease were unmistakable, and society viewed those who had it as unclean. This lasted for five centuries before a cure was found for it in the 1940s.
It wasn’t long before another disease would replace syphilis in terms of getting stigmatized. That disease is known as AIDS, and people were concerned about it for three reasons:
- the method of transmission (sex)
- its effect (incurable, death)
- the place of origin
AIDS back then would be labeled as the “African disease”, or “Haitian disease”. Another disease having a similar stigma was cholera and it was thought to have come from Asia or India.
Westerners believed that these diseases came from “primitive” parts of the world and were attacking the more developed civilizations.
We certainly don’t have the same notions for such diseases today although they have been replaced by a newer one called cancer. Some cancers are already curable, but one cannot deny the sinking feeling after finding out they got the big C.
What Effect Does Stigma Have on Diseases?
Opinions on people with gout have an effect. A very recent survey conducted by the Alliance for Gout Awareness revealed very interesting insights:
● 52% of people with gout feel embarrassed of their condition so they don’t talk about it.
● 40% of people look down on people with gout.
● 93% say they don’t know that gout is a form of arthritis.
● 46% of gout patients believe that diet alone causes gout.
● One in four patients think they can treat the disease with natural remedies (apple cider vinegar, cherry, etc.)
● 73% find it hard to get proper treatment. This may be because they’re not aware of the symptoms and the stigma surrounding it prevents them from taking action.
● One in four patients think gout can be cured.
Another study of 11 men with chronic gout found that, due to the stigma associated with the disease, they tend to minimize its impact, despite its severity. Because there is a lack of openness about the condition, there are only a few perspectives on it.
Finding a more effective gout treatment has thus become more difficult.
Treatment for Gout May Be Hampered by Stigma and Misinformation
According to recent survey results, stigma, ignorance, and misinformation may all be preventing people with gout from receiving treatment. Gout is a chronic condition marked by sudden, excruciating attacks.
169 gout patients from across the nation were surveyed by the Alliance for Gout Awareness to learn more about their experiences with the condition and opinions on treatment.
Almost all respondents (97%) recognized gout as a serious condition that could result in other health issues (90 percent). However, they acknowledged experiencing shame and embarrassment. They concurred that:
● Gout sufferers frequently feel embarrassed to talk about their condition (53 percent).
● People with gout are hated by society (40 percent).
This stigma may be brought on by general ignorance of gout. “Most people don’t know that gout is a type of arthritis,” most patients stated.
Outsiders are not the only ones who lack comprehension. Patients’ perceptions of the condition remain distorted. For example, nearly half (46%) of patients agreed that eating too much junk food and drinking too much alcohol can lead to gout.
While diet can influence disease development, genetics also play a role. Patients with gout may have a family history of the disease. And they should not feel helpless if dietary changes alone do not alleviate their gout symptoms.
Internalized and Expected Stigmatization in Gout Patients
Doctors investigated the relationship between stigma perception and demographic, clinical, and psychosocial variables in a well-known study. Doctors worked with a sample size of 50 patients with gout and prescribed urate-lowering medication.
Patients were asked to complete questionnaires about their perceived and internalized stigma, as well as a variety of other gout-related variables. According to the study, 26% experienced internalized stigma, 26% expected to be stigmatized by friends or family members, and 14% expected to be stigmatized by health care workers.
In conclusion, a subset of gout patients reported internalized and anticipated illness-related stigma. Stigma is associated with younger age, a negative emotional illness response, and intentions to not follow a prescribed treatment plan.
Gout Stigma: You Are Not Alone
You are not alone in facing this stigma; there are currently 8.3 million people in the United States who have the same disease as you. That’s one out of every twenty-five adults — quite alarming!
However, it’s also reassuring to know you’re not the only one thought to be living proof of the consequences of opulent living. After all, things could probably be much worse. Remember the lepers being shunned out of society? Yeah, we’re not as bad as we used to be.
Gout started to become more common around the 1970s to the 1990s. The likely culprit is obesity. It was around this same time that more and more people were becoming obese, and the condition is known to be the cause of many conditions like high blood pressure, hypertension, heart disease, metabolic syndrome, and yes, even gout.
If left untreated, gout can complicate your health and lead to more conditions. These include complications like tophi, joint deformity, kidney stones, cardiovascular disease, cataracts, and more.
Gout’s Long-Term Effects
These long periods when the patient feels fine between flares feed the myth that gout isn’t a big deal, which couldn’t be further from the truth. If untreated, gout can cause permanent joint damage, even between flares.
Some of the most serious side effects of untreated gout, according to rheumatologists, are destroyed joints that cause significant, irreversible pain and disability.
Potential long-term effects of gout:
Tophi
Tophi are urate crystal deposits that form beneath the skin in people who have chronic gout, also known as tophaceous gout. Tophi are hard bumps beneath the skin that are usually painless unless inflamed and swollen during a gout attack.
Tophi can erode the surrounding skin and joint tissues as they grow. This causes joint damage and, ultimately, joint destruction.
Kidney stones
Urate crystals, which cause gout symptoms, can also form in the kidneys. This can lead to the formation of painful kidney stones. High concentrations of urate kidney stones can impair kidney function.
Kidney disease
According to one study, many people who have gout also have chronic kidney disease (CKD). This can occasionally result in kidney failure. There is some debate over whether preexisting kidney disease causes the high uric acid levels that cause gout symptoms.
Seek Both Short- And Long-Term Gout Treatment
Gout should be treated aggressively and consistently to improve a patient’s long-term quality of life. Gout can be completely controlled with treatment.
Gout treatment is divided into two parts: reducing the short-term pain and swelling that occur during a flare, and gradually lowering uric acid levels to prevent future attacks.
During a flare, the main goal is to reduce painful inflammation as quickly as possible with oral medications such as:
● Colchicine
● Prednisone
● Ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs)
If only one joint is inflamed, a rheumatologist can quickly reduce swelling with a steroid injection.
Get Your Gout Symptoms Under Control Today
Most gout patients can lead normal lives if they are diagnosed early. Lowering your uric acid level can improve joint health and treat tophi if your disease has progressed. Medication and dietary or lifestyle changes can help with symptom relief in addition to reducing the frequency and severity of gout attacks.
As a gout patient, you have a personal responsibility to learn about the disease as much as you can. Gout treatment requires a significant amount of self-management. You must take your medication regularly and make long-term lifestyle changes.
That being said, you should stop blaming yourself. This self-defeating attitude benefits no one. If anything, you should be more open to talking about it. It can break people’s misconceptions about it and possibly lead to a more productive discussion about the best treatments.
What are your thoughts about the stigma on gout? Share your thoughts in the comments below!
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Disclaimer: This article is intended for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional for any health concerns.
