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Gout is an arthritic condition that causes inflammation of the joints. It mostly affects men over 40 and is usually associated with chronic hyperuricemia, a long-lasting abnormally high concentration of uric acid in the blood. The process leading to hyperuricemia and gout begins with the metabolism of purines, nitrogen-containing compounds that are important for energy. Purines can be divided into two types:

  1. Endogenous purines are manufactured within human cells.
  2. Exogenous purines are obtained from foods.

Alternative Names of Gout are: Hyperuricemia; Uric Acid

Complications of Gout

Gout rarely poses a long-term health threat if properly treated. It does, however, remain a source of short-term pain and incapacity for thousands of Americans.

  • Pain and Disability-Left untreated, gout can develop into a painful and disabling chronic disorder. Persistent gout can destroy cartilage and bone, causing irreversible joint deformities and loss of motion.
  • Kidney Conditions-
    • Kidney Stones- Kidney stones occur in between 10% and 40% of gout patients, and can occur at any time after the development of hyperuricemia. Although the stones are usually composed of uric acid, they may also be mixed with other materials.
    • Kidney Disease- About 25% of patients with chronic hyperuricemia develops progressive kidney disease, which sometimes ends in kidney failure.
  • Gout and Heart Disease-Gout often accompanies both risk factors for heart disease and heart disease itself. It is found in higher rates in people with obesity, high blood pressure, coronary artery disease, and congestive heart failure. Hyperuricemia, in fact, has been associated with a higher risk of death from heart conditions.

Other Medical Conditions Associated with Gout-

The following are some conditions that are associated with long-term gout:

  • Cataracts.
  • Dry eye syndrome.
  • Complications in the lungs (in rare cases, uric acid crystals occur in the lungs).

Causes of Gout

Uric acid is generated as the body's tissues are broken down during normal cell turnover. Some people with gout generate too much uric acid (10%). Other patients with gout do not effectively eliminate their uric acid into the urine (90%). Genetics, gender, and nutrition (alcoholism, obesity) play key roles in the development of gout.

  • If your parents have gout, then you have a 20% chance of developing it.
  • British people are five times more likely to develop gout.
  • American blacks, but not African blacks, are more likely to have gout than other populations.
  • Intake of alcoholic beverages, especially beer, increases the risk for gout.
  • Diets rich in red meats, internal organs, yeast, and oily fish increase the risk for gout.
  • Uric acid levels increase at puberty in men and at menopause in women, so men first develop gout at an earlier age (after puberty) than do women (after menopause). Gout in premenopausal women is distinctly unusual.

Attacks of gouty arthritis can be precipitated when there is a sudden change in uric acid levels, which may be caused by

  • overindulgence in alcohol and red meats
  • trauma
  • starvation and dehydration

Signs & Symptoms of Gout

Gout generally occurs in four (4) stages (asymptomatic, acute, intercritical and chronic) and has the following signs and symptoms:

Asymptomatic stage - urate levels rise in the blood, but produce no symptoms
Acute stage - symptoms usually lasting five to 10 days

  • sudden attack of joint pain
  • swelling
  • joints feel hot, tender and look dusty red or bruised

Intercritical stage - symptom-free intervals between gout episodes. Most people have a second attack from six months to two years, while others are symptom-free for five to 10 years.

Chronic stage

  • persistently painful joints with large urate deposits in the cartilage, membranes between the bones, tendons and soft tissues
  • skin over the deposits develop sores and release a white pus
  • joint stiffness
  • limited motion of affect joint

Diagnosis of Gout

The diagnosis of gout is based on symptoms, blood tests showing high levels of uric acid, and the finding of urate crystals in joint fluid. In chronic gout, x-rays show damage to the cartilage and bones.

Treatments of Gout

Currently, there is no cure for gout, but through proper diet, a healthy lifestyle and medications, the symptoms of gout can be relieved and further episodes eliminated.

Proper diet

  • Avoid or restrict foods high in purine (a substance that produces uric acid when broken down). These foods include: sardines, anchovies, brains, liver, kidneys, tripe, sweetbreads, tongue, shellfish (mussels and oysters), fish roe, scallops, peas, lentils, beans and an excessive amount of red meat.
  • Drink 10 to 12 eight-ounce glasses of non-alcoholic fluids daily.

Healthy lifestyle

  • Reduce alcohol consumption
  • Lose weight

Medications

Using medications for gout can be complicated, because the treatment needs to be tailored for each person and may need to be changed from time to time.

To relieve the pain and swelling of an acute attack, the doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, corticosteroid drugs, and/or adrenocorticotropic hormone (ACTH).

To prevent future attacks, the doctor may recommend colchicine, probenecid (Benemid, Parbenem or Probalan), sulfinpyrazone (Anturane), or allopurinol (Lopurin, Zurinol or Zyloprim).

To prevent or treat tophi, probenecid, sulfinpyrazone and allopurinol are recommended.

All of these drugs are powerful, so the patient needs to understand why they are taking them, what side effects may occur and what to do if they have problems with the medication

Prevention of Gout

To lower risk factors, consider:

  • supervised weight-loss program with exercise (if the patient is overweight)
  • avoiding a purine-rich diet
  • avoiding alcohol consumption, especially binge drinking
  • changing to another drug, if taking diuretics for hypertension

When to seek Medical Advice

If you experience sudden, intense pain in a joint, call your doctor. Gout that goes untreated can lead to worsening pain and joint damage. Seek medical care immediately if you have a fever and a joint is hot and inflamed, which can be a sign of infection.


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