Gout is a disease that can be dated back to ancient times, even documented in Egyptian texts stretching back to 2500 BCE. It is characterized by pain and inflammation when too much uric acid crystallizes and deposits in the joints. Symptoms of gout include severe pain, redness, and swelling in joints, most often the big toe jointof the foot. For this reason, as podiatrists, we are often the one to see these patients on initial presentation and make the diagnosis.
As a foot & ankle specialist seeing patients throughout this pandemic, I have noticed an increased incidence in acute gout flare ups presenting to the office. I discussed this anecdotal finding with several colleagues who themselves agreed that this observation was accurate and that the incidence of acute gout was markedly increased. After such discussions I decided to dig deeper and see why that might be?
For most people, the COVID-19 pandemic is a major source of fear and anxiety. There are significant stresses due to the shutdowns, whether financial, emotional, physical or a combination of the above. Can this undue stress contribute to acute gout? What aspect of stress is the contributing factor? The answer is yes, stress can manifest itself in a variety of unexpected wayswhich include:
- Changes in eating habits and/or sleep patterns
- Difficulty concentrating and/or sleeping
- Worsening chronic health problems
- Worsening mental health conditions
- Increased alcohol, tobacco and/or drug use
Many of these altered behavior patterns have a direct correlation with uric acid build up. Worse dietary habitsfor instance, may include eating foods high in corn syrup, drinking alcohol, eating processed meats. These are all purine rich foods which break down into uric acid directly increasing the potential for gout. I know the temptation for alcohol and snacking during our lockdown, I am guilty of it too.
Moreover, gout commonly occurs in combination with other medical problems. Conditions such as metabolic syndrome, obesity, hypertension, and abnormal lipid levels occur in nearly 70% of cases!COVID-19 fear and restrictions may be contributing to neglect of other health problems, worsening of conditions like diabetes, hypertension, obesity and other comorbidities that are proven to have a high association to gout.
As a podiatrist, I am indeed seeing a spike in these patients and I do believe this can be correlated to our altered behavior during this pandemic.
One must be mindful of our diets and behaviors during these times. If you are obese, diabetic, have kidney abnormalities or cardiac disease you are more susceptible to Gout. If you are susceptible gout you are likely more susceptible to complications associated with the COVID-19 virus as well so be extra careful. As COVID cases rise once again, let us work toward healthier habits and mindfulness to the guidelines that can decrease the risk for us and others around us.