African Journal of Biotechnology Vol. 10(40), pp. 7893-7895, 1 August, 2011 Available online at http://www.academicjournals.

org/AJB ISSN 16845315 2011 Academic Journals

Short Communication

Prevalence of gout in Gadap town, Karachi community, Pakistan

M. Akram1*, Khan Usmanghani1, Naveed Akhtar2, Pervaiz Akhtar Shah3, Tariq Saeed3, Qaiser Jabeen2, H. M. Asif2, S. M. Ali Shah2
2

Faculty of Eastern Medicine, Hamdard University, Karachi, Pakistan. Faculty of Pharmacy and Alternative Medicine, The Islamia University of Bahawalpur, Pakistan. 3 University college of Pharmacy, The university of Punjab lahore, Pakistan.
Accepted 20 May, 2011

This study was conducted to assess the prevalence of gouty arthritis in 100 patients (both male and female) between the ages of 35 and 70 years. The patients that were randomly enrolled in this study lived in Gadap town adjacent to Shifa-ul-Mulk Memorial Hospital, Madinat-al-Hikmah, Hamdard University, Karachi. The mean age of the 66 male patients was 53.59 with a standard deviation of 11.34 and the mean age of the 34 female patients was 58.59 with a standard deviation of 8.19. Consequently, this indicated high prevalence of gout in male than in female. It can be seen that between 35 and 40 years of age, the total number of patients was 11; between 40 and 45, it was 12; between 45 and 50, it was 13; between 50 and 55, it was 13; between 55 and 60, it was 15; between 60 and 65, it was 19; and between 65 and 70 years of age, it was 17. However, this clearly indicated that prevalence of gout was high in patients that are above 50 years of age. Key words: Gout, Gadap town, epidemiology, Pakistan. INTRODUCTION Few studies have been conducted on crystal arthropathy, although, there have been many reports on the cases of gout in Pakistan. Like other parts of the world, gout in Pakistan and India is frequently found in middle aged men and may lead to deformities and disabilities. Gout is one of the most common inflammatory arthritis, which is considered to be a true crystal deposition disorder caused by the formation of monosodium urate crystals in and around joints. Proper serum urate lowers treatment results in dissolution of the deposited urate crystals and now gout is taken as a curable disease (Zhang, 2006). A number of epidemiological studies from a diverse range of countries suggest that gout has increased in prevalence and incidence in recent years and that the clinical pattern of gout is becoming more complex. In particular, the greatest increase has been observed in primary gout in older men (Garg et al., 2005). It affects more than 1% of adults in the USA, and it is the most common form of inflammatory arthritis among men. Chronic gout or thophaceous gout is the result of lack of diagnosis and improper treatment (McCarty, 1994). Thus, special attention should be given to the diagnosis and treatment of gout. Fundamentally, the accumulating data support an increase in the prevalence of gout that is potentially attributable to recent shifts in diet and lifestyle, improved medical care and increased longevity (Beutler and Schumacher, 1994). Previously, a study was carried out to determine whether the prevalence of gout and/or clinically significant hyperuricemia increased in a population, where the health care was managed, for over 10 years in Pakistan. In that study, it was found that prevalence of gout in the overall study population increased during the 10-year period. When stratified by age, there were increases in prevalence among groups that are over the age of 65 in both sexes. Although, gout prevalence increased in both sexes over the 10-year period, men still had most of the burden of the disease. In persons younger than 65, men had 4 times higher

*Corresponding author. E-mail: makram_0451@hotmail.com. Tel: 92-021-6440083. Fax: 92-021-6440079.

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Table 1. Age of patients.

Sex

MeanNumber Standard deviation 11.34 8.19 10.61

Male 53.59 66 Female 58.59 34 Total 55.29 100

number of 840 out of 100,000 people, although, men tend to have higher uric acid levels than women. The international prevalence of hyperuricemia is 0.3%, but hyperuricemia has a 90% male predominance. Fairly, substantial proportion of patients with hyperuricemia (10 to 20%) has a family history of hyperuricemia (Kelley and Schumacher, 1993).
MATERIALS AND METHODS This cross-sectional community based study was undertaken in the rural area of Gadap town, Karachi. The study population included 100 people in the age group of 35 to 70 years for both sexes. Observation of monosodium urate (MSU) crystal was the gold standard for the diagnosis of gout. The results obtained were analyzed using SPSS software. Patients living in Gadap town, Karachi, were recruited into the study. Patients characteristics Hundred (100) people were randomly selected at Shifa-ul-Mulk Memorial Hospital for Eastern Medicine, Hamdard University, Karachi. Out of the 100 patients, 66 were male and 34 were female. The mean age and standard deviation were 53.59 and 11.34 for the males and 58.59 and 3.11 for the females (Tables 1 and 2).

Table 2. Distribution of age groups.

Age group 35-40 years 40-45 years 45-50 years 50-55 years 55-60 years 60-65 years 65-70 years Total

Total number 11 12 13 13 15 19 17 100

Table 3. Tophi formation in different parts of the body.

Tophi formation Tophi formation was seen in patients and number of patients was calculated according to the location of tophi formation. Detail of tophi formation in different parts of the body is shown in Table 3.

Tophi formation Big toe Pinna of ear Wrist Elbow Hand finger Knee joint Total

Frequency 30 22 18 16 10 4 100

Percent 30 22 18 16 10 4 100

RESULTS AND DISCUSSION The mean age of the 66 male patients was 53.59 with a standard deviation of 11.34 and the mean age of the 34 female patients was 58.59 with a standard deviation of 8.19. This indicated high prevalence of gout in male than in female. However, between the ages of 35 to 40 years, the total number of patients was 11; between 40 to 45 years, it was 12; between 45 to 50 years, it was 13; between 50 to 55 years, it was 13; between 55 to 60 years, it was 15; between 60 to 65 years, it was 19; and between 65 to 70 years, it was 17. This clearly indicated that prevalence of gout was high in patients that are above 50 years of age. This study was conducted to determine the prevalence of gouty arthritis in adults (35 to 70 years). The record of one hundred (100) diagnosed patients (both male and female) of gouty arthritis, living in Gadap town adjacent to Shifa-ul-Mulk Memorial Hospital, Madinat-al-Hikmah, Hamdard University, Karachi, was analyzed. The US prevalence of gout has risen, especially in persons over the age of 65 (Wallace et al., 2004). The apparent rise in the prevalence and incidence of gout over the past several decades may be caused by growing populations with risk factors for this disease, such as advanced age, high

prevalence than women (4:1 ratio), but in the older age groups (> 65), the gender gap narrowed to 1 woman to every 3 men with gout and/or hyperuricemia (3:1 ratio). However, there are both nonmodifiable and modifiable risk factors for hyperuricemia and gout. The nonmodifiable risk factors include age and sex. Gout prevalence increases in direct association with age; moreover, the increased longevity of populations in industrialized nations may contribute to a higher prevalence of gout through the disorder's association with aging-related diseases (such as, metabolic syndrome and hypertension) and treatments for these diseases (such as, thiazide diuretics for hypertension). It is estimated that approximately 15 of every 1,000 males between 35 and 45 years of age have hyperuricemia. Beer consumption is a common adjuvant cause of gout in the western world and is likely to be very low to absent in Muslim countries. Hyperuricemia afflicts an estimated

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intake of purine-rich animal protein, metabolic syndrome, diuretic use, organ transplant and end-stage renal disease (Brule et al., 1992). Polyarticular gout can mimic osteoarthritis (especially in elderly women) or rheumatoid arthritis. Hyperuricemia may be an independent cardiovascular risk factor, but treating asymptomatic hyperuricemia cannot be recommended until clinical trials demonstrated that lowering serum uric acid reduces cardiovascular risk (Yu et al., 1997). There is also a renewed interest in important associations between gout and other comorbidities like hypertension and cardiovascular disease. The importance of hyperuricemia on health considerations beyond the musculoskeletal system is an area worthy of even more study. Gout remains among the most common of all inflammatory arthritis with an incidence that appears to have risen from it. Evidence are accumulating to support lifestyle and dietary factors, such as heavy consumption of beer and liquor, as well as diets rich in meats and seafood as important gout risk factors. Conclusion Prevalence of gout is more in male as compared to female and it has been seen that gout occurs early in male as compared to female. Overall, occurrence of gout is more in adults and it has been concluded that gout occurs in female after menopause.

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