Gout and sport, a winning relationship. But without excess …

In the past it was the “pathology of the rich” or the “disease of kings and popes”, because it was associated with a type of diet and consumption of alcoholic beverages that was the prerogative of more affluent social classes. Charlemagne, the Sun King Louis XIV and Piero de ‘Medici, known as “the gouty”, father of Lorenzo the Magnificent, suffered from it. However, gout has been known since ancient times: first documented case in 2600 BC – in Egypt – when arthritis of the big toe was described. A problem that might seem niche and instead it involves a large segment of the population. On the impact of exercise in this type of patient, Official Active interviewed Dr. Elisabetta Greco, researcher at the Complex Operating Unit of Rheumatology of the Tor Vergata University Hospital, in Rome.

What is gout?

“A disease characterized by frequent attacks of arthritis and linked to the metabolism of purines, molecules found in various foods and beverages “.

What are the risk factors?

“A high concentration of uric acid, end product of purine metabolism, which exceeds 6.5 mg / dl in women and 7 mg / dl in men. Called hyperuricemia, it causes the intra and periarticular deposition of needle-like monosodium urate crystals, responsible for the painful episodes. It is linked to a diet rich in red meat, blue fish (sardines, anchovies, herring) or offal. Not to mention the excessive use of beer and spirits. Sometimes, however, there is an underlying renal insufficiency, or the concomitance of metabolic dysfunctions such as obesity, dyslipidemia and hyperglycemia ”.

How widespread is it?

“1-2% of the Italian population is affected. The disease is prevalent in males between the ages of 60 and 80, while in women it develops more frequently in the post-menopausal age ”.

How is the clinical picture during an attack?

“The pain is sudden and intense, with the joint appearing hot, red, swollen. In addition, there is functional impotence, which is the inability to use that joint. Symptoms worsen even at rest, at night. The medical student is taught that even the touch of the sheet becomes unbearable. And if the joint inflammation is particularly extensive, fever may appear ”.

What are the joints involved?

“The most affected is the first metatarsophalangeal. Hence the name gout. But also ankles, knees, wrists, hands. With the passage of time, the attacks occur after shorter and shorter intervals and the prolongation of the problem can lead to secondary arthrosis ”.

Are there any extra-articular complications?

“Yes, over the years there is a reduction in renal function, up to the picture of gouty nephropathy. Or clearly visible uric acid depositions, called tofi. These are solid nodules, yellow or white and painless, which however can undergo ulceration and infection, causing deformity “.

What does the therapy consist of?

“Some interventions aim at prevent arthritis episodes: the food sector is investigated, suggesting to the patient a diet with vegetables, dairy products, white meats. Treatment is based on uricosuric drugs, which promote the elimination of uric acid through diuresis, or allopurinol and febuxostat. In the acute attack, on the other hand, NSAIDs (non-steroidal anti-inflammatory drugs) or colchicine are used, which have an important action on pain and inflammation “.

What is the role of physical exercise?

“It’s a cornerstone of prevention, goes well with diet and weight loss. It also promotes the elimination of uric acid through diuresis ”.

What activities are recommended and how often?

“Exercise bikes, swimming and water sports, pilates, those that tone the muscles without traumatism on the joints. We cannot suggest intense aerobic disciplines, such as running. Any exercise should be done two to three times a week, continuously over time, away from acute attacks: the heat that develops during movement could worsen the picture “.

Is it true that excessive exercise can be harmful?

“Yes, during intense aerobic work there can be an excessive transformation into uric acid of ATP (adenosine triphosphate), a high-energy compound required by almost all metabolic reactions. This would trigger a vicious circle ”.