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Mar 19

Gout- for both the prince and the pauper

Gout- symptoms, etiology, diagnosis and treatment

 

What is gout?Gout

Gout is a type of arthritis that causes sudden onset of pain, redness, heat, and swelling in a joint. It is more common in men, and is rare in women before menopause. Although gout is caused by elevated levels of uric acid in the blood (called hyperurecemia), most people with hyperurecemia will never develop gout. The reason for this is not clear.

 

What causes gout?

Uric acid is a by-product of pruines, which is a component of the foods we eat. Uric acid is filtered and excreted through the kidneys. There is usually a fine balance between the production of the uric acid and its filtration in the kidneys, so the level stays constant. If this balance is altered, we can end up with too much uric acid. For example, eating foots with high purine content or kidney failure can lead to buildup of uric acid. Most gout cases are caused by underexcretion of uric acid through the kidneys.

 

Risk factors:

Gout used to be known as the disease of the kings. Now we know that is probably because historically the majority of people could not afford an abundance of meat and alcohol in their diet, except when they were wealthy. Now that purine-rich foods are accessible to more people, it can affect everyone- princes and paupers alike. These are some of the risk factors for developing gout:

  • Diet- large amounts of beef, seafood, high-fructose corn syrup (like sodas)
  • Alcohol- particularly beer. More than 1 drink/day for women and 2 drinks/day for men
  • Gender- gout is more common in men than in women. After menopause, women catch up!
  • Kidney disease
  • Obesity
  • Certain medications that can affect uric acid levels (like diuretics or water pills)
  • Low dose aspirin use
  • Injury
  • Recent surgery
  • Blood cancers

 

Gout symptoms

Acute gout

Sudden onset of severe pain in a joint, often associated with redness, swelling, and heat. The most common affected joint is the 1st toe, but any joint can be involved. The pain is worse at night, and may be so severe that one is not able to bear their bed sheets on their toe. Symptoms usually peak within 24 hours and resolve in 10-14 days.

 

Chronic gout

Whereas at the beginning, gout involves one joint at a time and there may be 1-2 years between attacks, as hyperurecemia and gout become chronic the gout-free periods shorten and more than one joint at a time may be affected. In severe cases, one attack can lead to another and there may be no gout-free period.

 

Tophaceous gout

After several years, large amounts of uric acid crystals deposit to form rock-like masses- or tophi- in the joints and their surrounding tissues. Tophi can cause erosion (eating away) of the joint and significant deformity.

 

Complications

People with gout are at increased risk of developing uric acid-containing kidney stones. Deposits of uric acid in the kidneys can also cause damage to the kidneys (urate nephropathy).

 

Reference:

UpToDate   http://www.uptodate.com/contents/gout-beyond-the-basics?source=search_result&search=gout+patient&selectedTitle=1%7E150

PubMed Health    https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022793/

Wikipedia  http://en.wikipedia.org/wiki/Gout

Web MD   http://arthritis.webmd.com/tc/gout-topic-overview

Firooz, Dr. Nazanin

Dr. Firooz is board-certified in Rheumatology and Internal Medicine. She is an active member of the American College of Rheumatology, and is affiliated with the Department of Rheumatology at Cedars Sinai Medical Center.

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