Table of Contents
What is Gout
Gout is a form of inflammatory arthritis. Gout develops when uric acid crystals form within the joint capsules, causing irritation and inflammation. Uric acid is a waste byproduct of the metabolism of forms of protein (nucleic acids) called purines.
Purines occur naturally in the body as well as in meats consumed in the diet (especially organ meats such as liver and fish such as mackerel and herring).
The most common site for gout is the first (largest) joint of the big toe. Gout may also affect the metatarsal and tarsal joints in the feet as well as the ankles and knee; it less commonly involves the fingers and wrists.
Symptoms and Diagnostic Path
Gout generally begins with sudden and severe pain in the affected joint, usually the first joint of the big toe. The pain commonly arrives at night and wakes the person. The affected joint may be red, swollen, and warm to the touch. The pain and other symptoms typically go away within 10 days, and there can be an extended period before symptoms return.
The diagnostic path includes X-rays of the affected joints and tests of the blood and urine to measure uric acid levels. Sometimes the doctor will numb the joint and use a needle and syringe to withdraw synovial fluid to examine for the presence of uric acid crystals. As gout progresses, often the uric acid crystals also form deposits, called tophi, under the skin.
Gout Treatment Options and Outlook
Treatment during a gout attack focuses on relieving inflammation and pain. Nonsteroidal antiinflammatory drugs (NASAIDS) or corticosteroid medications are generally the first line of medications to target these symptoms.
Medications to reduce the risk for future gout attacks include colchicine, allopurinol, and probenecid, which slow the body’s production of uric acid. These medications do not prevent gout from progressing but can extend the time between attacks as well as reduce the permanent damage the inflammation can cause.
|Foods with high Purine Content|
Risk Factors and Preventive Measures
About 20 percent of people who have gout also have other family members who have gout, giving rise to suspicion of a genetic factor. Circumstances that increase the amount of uric acid in the blood circulation significantly raise the risk for gout.
Such circumstances include consumption of foods high in purines, medications that affect the body’s ability to excrete purines (such as diuretic medications and immunosuppressive drugs after organ transplantation), diabetes, hyperlipidemia, and obesity. Excessive alcohol consumption interferes with the ability of the kidneys to filter uric acid from the blood.
Though there do not appear to be effective ways to prevent gout from developing, avoiding circumstances that increase blood uric acid levels can reduce the frequency and severity of gout attacks.
Men are more likely to develop gout before age 50 and women after age 50.
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