It usually occurs earlier in men than in women. It usually occurs after menopause in women. Men may be three times more likely than women to get it because they have higher levels of uric acid for most of their lives. Gout is a common form of inflammatory arthritis that is very painful.
It usually affects one joint at a time (often the big toe joint). There are times when symptoms worsen, known as exacerbations, and other times when there are no symptoms, known as remission. Repeated episodes of gout can cause gouty arthritis, a form of arthritis that worsens. Gout is a type of arthritis in which small crystals form in and around the joints.
It causes sudden attacks of severe pain and swelling. To diagnose gout, your doctor will review your medical history, a physical exam, and laboratory tests. You may remove fluid from the joint to detect urate crystals or order an x-ray, ultrasound, or MRI. Tell your doctor how severe the pain is, when it started, and which joints hurt.
You may be prescribed a medicine to lower your uric acid level. If you have a gout attack, place ice and raise your joint and drink plenty of non-alcoholic and sugar-free liquids. A prescription medication called colchicine helps relieve pain and swelling and should be taken at the first signs of an outbreak. If you don't have a prescription, take an anti-inflammatory drug, such as ibuprofen.
Outbreaks usually get better in a week or two. Work with your doctor and stick to your treatment plan, which may include medications and lifestyle changes, such as a healthy diet, regular physical activity and weight loss, if needed. While alcohol can cause gout attacks, genetics are much more important than alcohol in defining who gets it, and many people who never drink alcohol suffer from gout. In fact, it is believed that French royal families suffering from gout developed this condition more because of lead poisoning in the barrels used for their wine than because of the wine itself, since lead damages the kidneys and impairs their ability to remove uric acid from the system.
This situation has been imitated in more recent times, when drinkers of “illegal” whiskey, which is often made in lead-containing radiators, developed a droplet associated with lead poisoning (“Saturn droplet”). Excess body weight has also been associated with gout. The prosperous and overweight bourgeois with gout is a classic 19th century European image, but in reality gout affects people from all economic classes. It has been estimated that there may be up to five million people suffering from gout in the United States.
Even more conservative estimates put this figure at more than two million (Mayo Clinic estimate). Population studies at the Mayo Clinic and Taiwan have shown significant increases in the prevalence of gout recently, compared to the early 1990s. About 10% of gout cases are due to overproduction of uric acid. When uric acid is produced in excess, it is high not only in the blood but also in the urine, increasing the risk of gout and kidney stones.
Some people produce excessive uric acid due to a genetic defect in an enzyme in the purine breakdown pathway (see figure), which leads to hyperactivity in this pathway. Because cells contain DNA and DNA contains purines, anything that increases the breakdown of the body's cells can cause more uric acid and gout. For example, if a patient receives chemotherapy for a tumor, as the treatment destroys tumor cells, a gout attack or kidney stones may develop as a result of the breakdown of the purines in those cells. When thinking about gout, Wortmann has proposed a useful model: 1.Uric acid crystals can be thought of as phosphors, which can remain silent or can ignite.
The crystals can be present for years in cartilage, or even in joint fluid, without causing inflammation. Then, at some point, due to the increase in the number of crystals or another provoking factor, the matches “hit” and inflammation begins. This analogy is important both for conceptualizing uric acid crystals in the joint and for understanding the different types of treatment for gout (see below), some of which attack inflammation (pouring water over burning phosphors) and others removing uric acid crystals (removing phosphors). There are many circumstances where, no matter how ideal, there is no fluid or other specimen available for examination, but a diagnosis of gout is necessary.
A set of criteria have been established to help make the diagnosis of gout in this setting (see Table 1: Diagnosing gout when crystal identification is not possible). Some doctors would start colchicine after a very severe gout attack or two moderately severe gout attacks and, in addition, would use allopurinol. If a patient has two gout attacks in the same 12 months, it is generally recommended that they be treated with a drug to reduce uric acid, which colchicine does not achieve. See below for information on uric acid-reducing agents, allopurinol and probenecid.
Long-term use of colchicine has an uncommon effect on nerves and muscles, and a muscle blood test (CPK) is monitored at intervals of approximately six months in patients who take colchicine on a regular basis. Colchicine also plays an important role when patients begin treatment with allopurinol (see below) to prevent the increase in gout attacks that may occur when treatment with allopurinol is started. Colchicine, in that case, is often removed at about six months, assuming no gout attack has occurred. If a patient is allergic to allopurinol, there are often limited options.
If the rash was relatively mild, an oral desensitization regimen for that agent is an option. 11 This involves a pharmacist preparing a very low concentration allopurinol solution and then gradually increasing the concentrations over the course of a month. Although sometimes the rash will reappear during this process, the patient can often become desensitized in this way and subsequently tolerate allopurinol. Although some patients have a mild rash due to allopurinol that stays mild over time, or respond to antihistamines, it is not recommended to continue with allopurinol despite the rash, as the rash can worsen unpredictably.
Over time, increased levels of uric acid in the blood can cause deposits of urate crystals in and around joints. These crystals can attract white blood cells, leading to severe and painful gout attacks and chronic arthritis. Uric acid can also be deposited in the urinary tract and cause kidney stones. Gout affects more than three million Americans.
This condition and its complications occur more commonly in men, women after menopause, and people with kidney disease. Gout is closely related to obesity, hypertension (high blood pressure), hyperlipidemia (high cholesterol and triglycerides) and diabetes. Because of genetic factors, gout tends to run in families. .