GOUT

Gout

Gout

Introduction

Gout is a form of acute arthritis that causes severe pain and swelling in the joints. It most commonly affects the big toe, but may also affect the heel, ankle, hand, wrist, or elbow. It affects the spine often enough to be a factor in back pain. Gout usually comes on suddenly, goes away after 5-10 days, and can keep recurring. Gout is different from other forms of arthritis because it occurs when there are high levels of uric acid circulating in the blood, which can cause urate crystals to settle in the tissues of the joints (Crowson et al. 2002).

Description

Uric acid, which is found naturally in the bloodstream, is formed as the body breaks down waste products, mainly those containing purine, a substance that is produced by the body and is also found in high concentrations in some foods, including brains, liver, sardines, anchovies, and dried peas and beans. Normally, the kidneys filter uric acid out of the blood and excrete it in the urine. Sometimes, however, the body produces too much uric acid or the kidneys aren't efficient enough at filtering it from the blood, and it builds up in the blood stream, a condition known as hyperuricemia. A person's susceptibility to gout may increase because of the inheritance of certain genes or from being overweight and eating a rich diet. In some cases, another disease (such as lymphoma, leukemia, or hemolytic anemia) may be the underlying cause of the uric acid buildup that results in gout. An additional factor is occupational or environmental; it is now known that chronic exposure to high levels of lead decreases the body's excretion of urates, allowing uric acid to accumulate in the blood.

Causes

The cardinal feature of gout is the presence of an excessive amount of uric acid in PLASMA and various body tissues, and its deposition in the joints in the form of sodium monourate. The cause of this excess is not known, but there is an hereditary element and a family history of the disease in 50-80 per cent of cases. Inadequate exercise, habitual over-indulgence in animal food and rich dishes, and excess of alcohol have been indicated as precipitating factors, but the disease can occur in vegetarians and teetotallers.

Gout is infrequent before the age of 40, but it may occasionally affect very young people in whom there is a strong family history. About 95 per cent of patients are male. In women it most often appears during the menopause (Coghill, 2004).

Symptoms

An attack of gout may appear without warning, or there may be premonitory symptoms. The affected joint is swollen and the symptoms come and go, usually being worse at night. Tophi may develop around an affected joint. Urinary CALCULI (urate-based) often occur in patients with gout.

Diagnosis

Usually, physicians can diagnose gout based on the physical examination and medical history (the patient's description of symptoms and other information). Doctors can also administer a test that measures the level of uric acid in the ...