Gout

Gout results from an overload of uric acid crystals in tissues of the body resulting in recurring attacks of joint inflammation. Chronic gout can lead to painful deposits in and around the joints, decreased kidney function and kidney stones. It is often related to an inherited abnormality in the body's ability to process uric acid, the product of purines that are found in many common foods.

The small joint at the base of the big toe is the most common site of an acute gout attack of arthritis. Other joints that can be affected include the ankles, knees, wrists, fingers, and elbows. Acute gout attacks are characterized by a rapid onset of pain in the affected joint followed by warmth, swelling, reddish discoloration, and marked tenderness. The attacks may last a few hours or several days.

While an elevated blood level of uric acid (hyperuricemia) may indicate an increased risk of gout, many patients with hyperuricemia do not develop it and still others with repeated gout attacks have normal or low blood uric-acid levels. Besides an inherited abnormality in handling uric acid, other risk factors for developing gout include obesity, excessive weight gain, heavy alcohol intake, high blood pressure, and abnormal kidney function. Certain drugs can also cause elevated uric-acid levels in the blood. Furthermore, diseases such as leukemias, lymphomas, and hemoglobin disorders lead to excessive production of uric acid.

The most reliable test for gout is finding uric-acid crystals in the joint fluid obtained by joint aspiration (arthrocentesis). X-rays may show tophi-crystal deposits and bone damage as a result of repeated inflammations.

Prevention of acute gout involves maintaining adequate fluid intake, weight reduction, dietary changes, reduction in alcohol consumption and medications to lower the uric-acid level in the blood (reduce hyperuricemia). According to the American Medical Association, a balanced diet for people with gout include foods high in complex carbohydrates (whole grains, fruits, vegetables), low in protein (15% of calories and sources should be soy, lean meats, poultry) and with no more than 30% of calories from fat (10% animal fat).

Medication includes pain relievers such as acetaminophen to manage pain. Antiinflammatory agents such as nonsteroidal antiinflammatory drugs (NSAIDS), colchicine, and corticosteroids are used to decrease joint inflammation. Other medications are then considered for treating the elevated levels of uric acid in the blood.

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