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Beware of the ‘revenge of the wife’

One medical condition that is not given the attention due it is high uric acid level (hyperuricemia) with gout.

Gout, characterized by excruciating pain in the joints caused by high uric acid levels, is described by Dr. Michael Doherty, professor of rheumatology at the University of Nottingham in the United Kingdom, as the “revenge of the wife” because it disproportionately affects men more than women, especially those who overindulge themselves in alcohol and pulutan rich in the precursors of uric acid, such as chicharon, meat, bopis (internal organs) and nuts.

However, despite the gout pain that patients experience, the ailment is still relatively undertreated compared to other medical conditions. Sometimes, doctors give this diagnosis with a smile, implying it is not as bad as having elevated cholesterol or blood sugar levels, or anywhere close to being diagnosed with high blood pressure.

There is generally haste and a sense of urgency in treating increased blood sugar and cholesterol levels, which is rightfully so. But there’s a passive attitude when high uric level is detected.

Ed Susman, US-based contributing editor of H&L (Health and Lifestyle), reports in the August issue of the magazine the wide and growing prevalence of hyperuricemia with gout, which has increased hospitalization rate more than fourfold in the last 22 years.

He cites the statistics presented by Gurkipal Singh, M.D., adjunct professor in clinical medicine at Stanford University, and chief science officer of the Institute for Clinical Outcomes Research and Education, Woodside, California, in the recent annual meeting of the European Congress of Rheumatology.

Based on data from the US, Dr. Singh believes that generally, the population is getting healthier. Since 1993, the US population has increased 25 percent, but hospitalization for all causes, on the average, has increased only 4.8 percent.

Through the roof

However, the hospitalization for hyperuricemia with gout has alarmingly gone through the roof in the same period.

“All-cause hospitalizations in patients with gout in the US have significantly increased by 410 percent in the last 22 years,” Dr. Singh reports.

The under-recognition is similar in most parts of the world, including the Philippines. We have very sparse data on the prevalence of high uric acid level, compared to the repeated prevalence surveys we have on diabetes, hypertension and hypercholesterolemia.

The harmful effects of high uric acid levels in the blood are not limited to the joints. It can form stones in the kidneys, which can likewise cause excruciating pain when the kidney tubules, where the urine passes, are blocked.

Now there is also good reason to believe that hyperuricemia may be a risk factor for heart disease, and other problems in the arteries. Indeed, if high uric acid is such a strong irritant to the joints, how much more to the sensitive inner lining of the arteries called the endothelium?

Hence, it can cause endothelial dysfunction, which leads to the progressive narrowing of the arteries called atherosclerosis.

Ultimately, it may lead to heart attack, stroke, as well as erectile dysfunction.

So, the description “revenge of the wife” may be apt for philandering husbands with hyperuricemia and its complications.

Hyperuricemia is also associated with hypertension. We have noted that some patients with difficult-to-treat high blood pressure find their illnesses better controlled when their high uric acid levels are reduced by diet and medicines.

For patients with mild hypertension and hyperuricemia, I suggest that the hyperuricemia be treated first without initiating antihypertensive therapy. In most instances, the blood pressure goes down automatically upon the control of the hyperuricemia.

For men with high uric acid, beware of the “revenge of the wife” because it can really make life complicated.

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