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Disease of the Month

Rheumatology & Immunology

Definition

You wake up in the middle of the night, and your big toe feels as if it's on fire. It's hot, swollen and so tender that the weight of the blanket on it is nearly intolerable. If so, you might be experiencing an acute attack of gout (or gouty arthritis) a form of arthritis that's characterized by sudden, severe attacks of pain, redness and tenderness in joints. Gout has been recognized for more than 2,000 years, making it one of humankind's oldest known diseases. In the past, gout was often known as "the disease of kings" because it was associated with wealthy men who overindulged in rich food and drink. Today, it's known that gout is a complex disorder that can affect anyone. In fact, it's a painful problem for more than 2 million Americans. It's true that men are more likely to get gout, but women become increasingly susceptible to it after menopause. Fortunately, gout is treatable, and there are ways to keep it from recurring.

The pain and swelling associated with gout are the result of the bodys response to the accumulation of urate crystals in the affected joint. Enlarged circle shows microscopic view of urate crystals.

Causes of Gout
Almost all people who have gout have too much uric acid in their blood, a condition called hyperuricemia. However, there are many people who have hyperuricemia but not gout. Hyperuricemia is caused by one or both of the following conditions: 1. The kidneys can't get rid of uric acid fast enough. 2. The body makes too much uric acid. The use of diuretic medications or "water pills" can often cause hyperuricemia. Diuretics are used to get rid of excess body fluid and to lower high blood pressure. However, diuretics can hamper the kidneys' ability to remove uric acid, thus raising uric acid levels in the blood.

Inherited traits and other factors such as diet, weight, and alcohol use can also play a role in causing gout.

Signs & Symptoms

Episodes develop very quickly, and the first episode often occurs at night. Episodes may be caused by the following: Drinking too much alcohol Eating too much of certain foods
(Sardines, Anchovies, Broth, Gravy, Brains, Livers, Kidneys, and Sweetbreads)

Surgery Sudden, severe illness Crash diets Joint injury Chemotherapy

Diagnosis
Your doctor may withdraw fluid from the affected joint to detect crystals of uric acid within your white blood cells. He or she may also ask for a urine sample and a blood test. A urine sample can provide information on how much uric acid youre excreting. A blood test can indicate levels of uric acid in your blood.

Treatment
Gout treatment mainly consists of taking medication(s) and watching your diet. The goals of treatment are to relieve pain, shorten the duration of inflammation during an acute episode, prevent future episodes, and prevent joint damage. Common medications that are used to treat gout are Colchicine, NSAIDs (Nonsteroidal Anti-Inflammatory Drugs), and Prednisone. These medications are aimed at relieving pain and swelling that is associated with gout. Dietary & lifestyle changes can greatly decrease your risk for developing gout. Keep in mind the following: Try to avoid or limit your intake of certain foods (see "Signs & Symptoms" list above). Obesity can be linked to high uric acid levels in your blood. Limit your alcohol level as too much alcohol can also raise uric acid levels in your blood. Drink 10-12 eight-ounce glasses of non-alcoholic fluid daily to help "flush out"

uric acid crystals from your body.

For more information on Gout, please visit these informative sites.

Copyright 2002, Arthritis Foundation. All Rights Reserved. 1998-2002 Mayo Foundation for Medical Education and Research. All rights reserved.

For other "Disease of the Month" features click below: Arthritis ~ Lupus ~ Raynaud's Phenomenon
Last modified on: October 4, 2002

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