Gout

Gout is a disease that results when crystals of uric acid form in tissues of the body. Gout is characterized by an overload of uric acid in the body and recurring attacks of joint inflammation (arthritis). Chronic gout can lead not only arthritis, but hard lumps of uric acid in and around the joints, decreased kidney function, and kidney stones.

Gout was historically known as "the disease of kings" or "rich man's disease".

Cause

Hyperuricemia is the underlying cause of gout where level of uric acid in the blood is abnormally high. Uric acid is created when the body breaks down purine. Causes include increased production due to purine-rich diet and increased purine metabolism, decreased excretion of uric acid due to kidney disease and certain drugs or a mixture of both.

Diet
Dietary causes account for about 12% of gout, and include a strong association with the consumption of alcohol, fructose-sweetened drinks, meat, and seafood. Diet alone generally is not sufficient to cause gout.

Recent studies have found dietary factors once believed to be associated are in fact not, including the intake of purine-rich vegetables and total protein. Coffee, vitamin C and dairy products consumption and physical fitness appear to decrease the risk.

Genetics
The occurrence of gout is partly genetic. If your parents have gout, then you have a 20% chance of developing it.

Medical conditions
Gout frequently occurs in combination with other medical problems. Metabolic syndrome, a combination of abdominal obesity, hypertension, insulin resistance and abnormal lipid levels occurs in nearly 75% of cases.

Medication
Diuretics have been associated with attacks of gout. However, a low dose of hydrochlorothiazide does not seem to increase the risk. Other medicines that have been associated include niacin and aspirin.

Symptoms

The first symptom of gouty arthritis is typically the sudden onset of a hot, red, swollen joint. The most common joint involved is at the base of the big toe (~50% of cases), but almost any joint can be involved. In some people, the acute pain is so intense that even a bed sheet on the toe causes severe pain. Acute gouty arthritis at the base of the big toe is referred to as podagra.

Even without treatment, the first attacks stop spontaneously after one to two weeks. While the pain and swelling completely go away, gouty arthritis commonly returns in the same joint or in another joint.

With time, attacks of gouty arthritis can occur more frequently and may last longer. While the first attacks usually involve only one or two joints, multiple joints can be involved simultaneously over time.

Treatment

The initial aim of treatment is to settle the symptoms of an acute attack. Repeated attacks can be prevented by different drugs used to reduce the uric acid levels. Ice applied for 20 to 30 minutes several times a day decreases pain and reducing inflammation.

It may be helpful to keep the swollen joint elevated above your chest as much as possible. Maintaining adequate hydration is key for minimizing attacks.

Prevention

If you are at risk for gout, you should do the following:

• Eat a low-cholesterol, low-fat diet. People with gout have a higher risk for heart disease. This diet would not only lower your risk for gout but also your risk for heart disease. Control your cholesterol.
• Avoid foods that are high in purines (the biochemical in foods that is metabolized into uric acid), including shellfish and red meats.
• Slowly lose weight. This can lower your uric acid levels. Losing weight too rapidly can occasionally precipitate gout attacks.
• Restrict your intake of alcohol, especially beer.
• Stay hydrated.
• Increase your intake of dairy products, such as nonfat milk and yogurt, because they can lower the frequency of gout attacks.
• Avoid fructose, such as in corn syrup and diet sodas.
• Talk to your doctor if you are taking thiazide diuretics (hydrochlorothiazide, HCTZ), low-dose aspirin, levodopa, cyclosporine, or nicotinic acid.