The chronicity of the treatment increases the chances of remission, emphasizes dr. Alexander.
Charlemagne (742-814), Henry VIII King of England (1491-1547). Fotos: Shutterstock
Studies during the last decade supported a considerable increase in patients diagnosed with drop in various countries of the world, such as New Zealand and England. This disease is more common in men than in women, and is the result of imbalances in uric acid in the blood, leading to the formation of crystals in the joints and other body tissues.
However, despite this recent increase in patients, the drop It was already listed historically as the "disease of kings", since it was directly related to unhealthy lifestyle habits, such as excessive alcohol consumption and high protein intake, especially if we take into account that, for some years, access to red meat was exclusive to the upper class, kings, nobles and wealthy families.
Historians suggest that great personalities such as Henry VIII of England, Charlemagne, among others, suffered from drop. And, given the social and health conditions of the time, this disease was considered benign with respect to others, since it forced the affected person to rest in their rooms, generally luxurious, receiving large quantities of food and drinks from the service.
Interestingly, and despite the fact that it is now recognized as the disease of the big toe, this condition received the name in the Middle Ages, when it was thought that there was a leak "drop a drop"to the interior of the joints of bad blood humors.
However, the treatment that was recommended for these people consisted of following a strict diet to mitigate the effects of the drop about the organism. However, most of the patients did not comply with these recommendations, worsening their physical condition and, of course, their health.
Modern treatments for drop
During a recent awareness and education event on rheumatic conditions organized by the Puerto Rican Foundation for Rheumatic Diseases (FER), Reuma Expo 2022, Dr. Paloma Alejandro, a rheumatologist and member of the board of directors of said foundation, confirmed that these excretion or overproduction of uric acid are strongly linked to the type of diet that the patient takes.
"The crystals that form in these joints usually create an inflammatory chain, that is, an autoimmune response that will create a lot of inflammation and destruction of the joint," Dr. Paloma mentioned.
Usually the drop It is recognized as inflammation of the big toe, despite the fact that its manifestation is not exclusive to this area of the body, as it can affect joints such as the knees, shoulders, hands or elbows.
In addition, this condition is characterized by manifesting itself through sudden attacks that include redness and swelling of the affected areas.
"Unfortunately, it tends to be a difficult condition to control, because it can cause many attacks of inflammation in the joints. There are patients for whom this disease prevents them from walking," added Dr. Alejandro. "Inflammation can last for days if not treated properly."
Usually the drop It is diagnosed more frequently in young men, although it also develops in women after menopause, and usually occurs in patients with comorbidities such as hypertension, kidney problems and/or cardiomyopathies.
High levels of uric acid in the body
In addition to the crystals that can form in bone joints, high levels of uric acid they can contribute to the formation of small concentrations of masses in the joints and skin, called tophi, which can sometimes even be confused with skin carcinosis.
Also, it is possible for these accumulations to develop in cartilaginous tissue, tendons and soft tissues, usually only after the disease has been suffered for many years.
"I like to talk about drop as a systemic condition, because in recent years it has been discovered that, in the same way that this uric acid it is deposited in the joints and causes inflammation and destruction, it has the ability to deposit in the coronary arteries, in the kidneys, or in other parts of the organs where it will cause that same immune response and tissue destruction".
The good news is that, for several years now, medicine has had treatment alternatives to eliminate tophi, including new oral and intravenous medications that control the levels of uric acidfavoring, in the same way, renal function and blood pressure.
"You have to pay attention to the drop because with treatment, damage to the joint can be avoided; it must be seen as a chronic condition where the use of medication will always be necessary to maintain remission", highlights the rheumatologist. "I have seen many patients who arrive at my office unable to walk, with ankles already stiff and with replacements of some joints because, perhaps, the drop It was not adequately treated or controlled."
The treatment of this condition must be chronic, that is, it must be continued even when the patient does not present symptoms of drop; this increases the probability of achieving remission. Medications suggested for patients with drop, are usually corticosteroids, which help control the inflammation and pain of the disease. They can be given as tablets or injected directly into the affected joint.