GOUT
What Is Gout?
Gout is one of the most painful rheumatic diseases. It results from deposits of needle-like crystals of uric acid in the connective tissue, joint spaces, or both. These deposits lead to inflammatory arthritis, which causes swelling, redness, heat, pain, and stiffness in the joints.
Uric acid is a substance that results from the breakdown of
purines or waste products in the body. If the body increases
its production of uric acid or if the kidneys do not eliminate
enough uric acid from the body, levels build up (a condition
called hyperuricemia). Hyperuricemia may also result when a
person eats too many high-purine foods, such as liver, dried
beans and peas, anchovies, and gravies. Hyperuricemia is not
a disease and by itself is not dangerous. However, if excess
uric acid crystals form as a result of hyperuricemia, gout can
develop. The excess crystals build up in the joint spaces, causing
inflammation. Deposits of uric acid, called tophi, can appear
as lumps under the skin around the joints and at the rim of
the ear. In addition, uric acid crystals can also collect in
the kidneys and cause kidney stones.
Who Is Likely To Develop Gout?
Men are more likely to develop gout than women, and men aged 40 to 50 are most commonly affected. Women rarely develop gout before menopause. The disease affects men and women differently: Men tend to develop gout at an earlier age than women, and alcohol is more often associated with the development of the disease in men. Gout is rare in children and young adults.
What are the Signs and Symptoms of Gout?
- Hyperuricemia
- Presence of uric acid crystals in joint fluid
- More than one attack of acute arthritis
- Arthritis that develops in 1 day
- Attack of arthritis in only one joint, usually the toe, ankle, or knee
- A painful joint that is swollen, red, and warm
How Is Gout Diagnosed?
Gout may be difficult for doctors to diagnose because the symptoms may be vague and often mimic other conditions. Although most people with gout have hyperuricemia at some time during the course of their disease, it may not be present during an acute attack. In addition, hyperuricemia alone does not mean that a person has gout. In fact, most people with hyperuricemia do not develop the disease.
To confirm a diagnosis of gout, doctors typically test the fluid in the joint, called synovial fluid, by using a needle to draw a sample of fluid from a person's inflamed joint. The doctor places some of the fluid on a slide and looks for monosodium urate crystals under a microscope. If the person has gout, the doctor will almost always see crystals. Their absence, however, does not completely rule out the diagnosis.
How Is Gout Treated?
With proper treatment, most people with gout are able to control their symptoms and live normal lives. Gout can be treated with one or a combination of therapies. Treatment goals are to ease the pain associated with acute attacks, prevent future attacks, and avoid the formation of new tophi and kidney stones.
For some people, the doctor may prescribe either NSAID's
or oral colchicine in small daily doses to prevent future attacks.
If attacks continue and tophi develop, however, the doctor may
prescribe medicine to treat hyperuricemia, most commonly allopurinol
(Zyloprim) and probenecid (Benemid).