What is Gout?
For centuries, gout was called the "disease of kings"
because it seemed to attack the rich and well-fed who drank plenty of alcohol.
You don't have to be a king to get gout, but the rest is true: If you are a heavy,
middle-aged man who drinks large amounts of alcohol and has a diet rich in
proteins, you are at risk of developing gout.
Gout is a painful arthritis caused by hyperuricemia -- high blood levels of a
chemical called uric acid. People with gout often can't excrete enough uric acid,
make too much of it, or both. Uric acid is a substance your body forms as a
breakdown product of purines, which come from foods such as meats, some fish,
and alcohol (purines are also made in your body).
What happens in your joints
Normally, uric acid circulates in the bloodstream and is
eliminated through the kidneys in the urine. In people with gout, uric acid
builds up in the blood and forms sharp crystals that collect in the joints
and soft tissues, causing inflammation and sometimes agonizing pain.
Gout attacks without any warning, often in bed at night. A first attack of
gout usually begins in the coolest joint -- most commonly the big toe. Other
targets include the ankles, heels, knees, and wrists, and eventually almost
any joint if the condition goes untreated. The first attack is intense; the
pain can be so severe that it can be excruciating to put even a bedsheet over
the area. The affected joint swells and the skin becomes taut, shiny, reddish-purple,
and hot. Touching or moving the joint is an agonizing experience.
Usually, the first few attacks last only a few days. But if the disorder progresses,
untreated episodes last longer, happen more often, and affect more joints, eventually
causing permanent damage. High levels of uric acid can also cause kidney stones. Left
untreated, gout may lead to the following complications:
Deformed joints and reduced mobility
Kidney stones
Inflammation of the bones, tendons, and ligaments
Although women do get gout, it is much more common in
men. (Women catch up with men after menopause.) Gout can, very rarely, show
up in young children, usually due to an inherited abnormality in purine
metabolism.
Symptoms
Acute joint pain at one site, usually the big toe
Swelling, redness, warmth, and extreme tenderness of the joint
Fever, chills, fatigue, and loss of appetite
If untreated, more symptoms appear
Recurrent attacks, which last longer and become more frequent
Uric acid deposits in soft tissues, including the ear, elbows, knees, and fingers
Kidney stones or kidney pain (on either side below the ribs)
How gout is diagnosed
Your doctor will examine you and ask about your medical history
and any family history of gout. Laboratory tests for gout include checking for uric
acid in the blood and urine, and analysis of joints and soft tissue for uric acid
deposits. These include:
Blood sample to check for elevated uric acid level -- more than 7.5 mg./dl. (milligrams per deciliter)
Urine analysis to check the level of uric acid by the kidney
Samples of tissue or of joint fluid to check for uric acid crystals
A complete blood count
In the later stages of gout, X-rays or other imaging tests
document the amount of joint damage.
Risk factors
Being a middle-aged man or a postmenopausal woman
Being overweight
Consuming large amounts of alcohol and foods with purines, such as red meats
Heredity -- if someone in your family has gout, you're more at risk
Undergoing chemotherapy or radiotherapy, which rapidly destroys cells and releases additional uric acid into the blood.
The following drugs may promote the development of gout by raising blood uric acid levels
Acetazolamide (Diamox)
Antineoplastic drugs (used in chemotherapy)
Aspirin (aggravates hyperuricemia)
Ethacrynic acid (Edecrin)
Diuretics (potassium-sparing diuretics, thiazide diuretics)
Ethambutol (Myambutol)
Pyrazinamide
Treatment for Gout
Successful treatment includes tissue cleansing, counseling,
dietary, lifestyle modifications.
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