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Gout is a painful medical disorder affecting the joints. It is also a type of inflammatory arthritis. This image shows Gout of the big toe.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Gout, NOS

What is Gout? (Definition/Background Information)

Gout is a painful medical disorder affecting the joints. It is also a type of inflammatory arthritis. The other significant features of Gout are:

  • It is episodic with periods of quiescence and  exacerbation (the condition alternates between periods of dormancy and severe pain)
  • Most commonly Gout affects the big toe, at the metatarsal-phalangeal joint. But, it may affect other joints too
  • The main cause of Gout is high levels of blood uric acid, which crystallizes and deposits at the joints
  • A tophus is the accumulation of uric acid within the body tissue, resulting in painful swelling. Tophus occurs when high levels of uric acid are present in the body for a prolonged period
  • Gout is generally managed using medications and by bringing about lifestyle and food habit changes

Who gets Gout? (Age and Sex Distribution)

Both men and women are affected by Gout, however:

  • It is more frequently seen among men
  • There is an increased incidence seen in women, after menopause
  • Some racial predilection is observed (Pacific Islanders, Maoris, African Americans, are at an increased risk)
  • Gout is more frequent in some geographic regions like Polynesia, sub-Saharan Africa, and China

What are the Risk Factors for Gout? (Predisposing Factors)

Some of the risk factors for Gout include:

  • The use of certain medications that elevate blood uric acid levels
  • Some medications decrease uric acid removal from the body, resulting in high levels of uric acid in the blood
  • Some individuals suffer an interference of uric acid removal from the body, due to various reasons
  • Those suffering from conditions, such as diabetes, obesity, anemia, blood cancer, and kidney disease, are at an increased risk
  • There is a genetic predisposition observed; Gout can run in the families, for generations
  • An advancing age, individuals of certain race, and spring seasons, are other factors that are known to increase the intensity of Gout

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Gout? (Etiology)

  • Gout is caused due to high levels of uric acid in blood, a condition known as hyperuricemia
  • This happens due to family history, certain medications, diet (consumption of alcohol, meat, seafood and sweetened drinks)
  • A ‘reduced’ or ‘very low’ level of uric acid excretion from the body, causes accumulation of the compound
  • Not all with high uric acid levels develop gout, but there is a 10% chance
  • Gout is also associated with other medical complications such as obesity (abdominal), high lipid levels, resistance to insulin, and hypertension
  • Other conditions include exposure to lead and lead products, which is caused either due to an occupation-based exposure, or an increased  dietary intake of the substance

What are the Signs and Symptoms of Gout?

Signs and symptoms of Gout include:

  • Painful, and inflamed (swollen and tender) metatarsal-phalangeal joint
  • The pain can be excruciating, unbearable, and occurs mostly during the night
  • Other joints like knees, wrists, fingers, heel, etc. maybe affected
  • Sometimes high fever and tiredness is felt
  • Formation of tophi (hard uric acid crystal deposits) in the joints and bones

How is Gout Diagnosed?

A diagnosis of Gout would involve:

  • Physical examination and evaluation of medical history
  • Analysis of synovial fluid for uric acid crystals, where a sample is taken from the affected joints. The synovial fluid sample is aspirated and examined under a microscope, for the presence of uric acid crystals
  • A blood test may reveal the disorder. Hyperuricemia is a classical sign that indicates the presence of Gout
  • X-rays of the affected joints
  • Urine test for uric acid

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Gout?

Individuals with long-standing Gout can have the following complications:

  • Problems related to the eye, such as cataract, dry eyes
  • Occasionally, uric acid crystals in the lungs resulting in lung issues
  • Gouty arthritis
  • Very high levels of uric acid in blood can cause uric acid type kidney stone formations; especially, if the individual loses weight rapidly
  • Kidney failure

How is Gout Treated?

Treatment of Gout is aimed at reducing the symptoms and preventing repeated attacks. Treatment measures include:

  • Treating other complications/diseases (co-morbidities) associated with Gout is important; these have to also be considered
  • Drugs (NSAIDs) are used to reduce blood uric acid levels. These drugs should be used with caution, when other conditions like heart, kidney failure, and gastric problems, are observed
  • Certain medications may have side effects; hence, some are used only when Gout attack is acute
  • Steroid injections (to the joints) may also be recommended by the physician
  • Pain relief can be obtained by application of ice pack, several times a day, or by using painkillers
  • Avoid fats, seafood, meat, and high-fructose foods; meet the body’s requirement of carbohydrates

How can Gout be Prevented?

A few preventive measures for Gout would include:

  • Modifications to lifestyle(exercises, physical activities) and dietary choices influence positively
  • Reduce the consumption of meat and seafood, and prevent obesity
  • Daily adequate intake of vitamin C is known to decrease the incidence of Gout

In individuals with a high risk of Gout, the symptoms can be delayed by making appropriate dietary and lifestyle changes. In such cases, the prevention may be difficult, but the onset of symptoms can be delayed.

What is the Prognosis of Gout? (Outcomes/Resolutions)

  • If treated properly, individuals with Gout can lead a normal life
  • Gout increases the chances of other complications/disorders, like hypertension, diabetes, renal and cardiovascular diseases
  • Even a severe attack of Gout may resolve itself within 7 days; however, there is a high probability of recurrence
  • Without treatment, chronic Gout may develop, destroying joints and aiding the formation of tophi. This would demand intense treatment measures
  • Side effects of the administered drugs may complicate treatment process. These side effects, like renal dysfunction, depend on the kind of drugs taken

Additional and Relevant Useful Information for Gout:

Gout is one of the oldest diseases known to man. It used to be referred to as the ‘king of diseases’, or ‘disease of kings’.

What are some Useful Resources for Additional Information?

The Gout Academy
c/o KnowledgePoint360 Group, LLC.
125 Chubb Avenue, Lyndhurst, NJ 07071
Email: info.thegoutacademy@hcpknowledge.com
Website: http://www.thegoutacademy.com

Arthritis Foundation
1330 W. Peachtree Street.; Suite 100 Atlanta, GA 30309
Phone: (404) 872-7100
Toll-Free: 1 (800) 283-7800
Website: http://www.arthritis.org

American College of Rheumatology
2200 Lake Boulevard NE Atlanta, GA 30319
Phone: (404) 633-3777
Fax: (404) 633-1870
Email: acr@rheumatology.org; arhp@rheumatology.org; foundation@rheumatology.org
Website: http://www.rheumatology.org

Gout & Uric Acid Education Society
Website: http://gouteducation.org

References and Information Sources used for the Article:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001459/ (accessed on 8/27/12)

http://www.mayoclinic.com/health/gout/DS00090 (accessed on 8/27/12)

Helpful Peer-Reviewed Medical Articles:

Ar'ev, A. L., Kunitskaia, N. A., & Kozina, L. S. (2012). [Gout and hyperuricemia today: prevalence, risk factors, features in the elderly]. Adv Gerontol, 25(3), 540-544.

Crittenden, D. B., & Pillinger, M. H. (2013). New therapies for gout. Annu Rev Med, 64, 325-337. doi: 10.1146/annurev-med-080911-105830

Dalbeth, N., & Choi, H. K. (2013). Dual-energy computed tomography for gout diagnosis and management. Curr Rheumatol Rep, 15(1), 301. doi: 10.1007/s11926-012-0301-3

Doghramji, P. P., & Wortmann, R. L. (2012). Hyperuricemia and gout: new concepts in diagnosis and management. Postgrad Med, 124(6), 98-109. doi: 10.3810/pgm.2012.11.2616

George, R. L., & Keenan, R. T. (2013). Genetics of hyperuricemia and gout: implications for the present and future. Curr Rheumatol Rep, 15(2), 309. doi: 10.1007/s11926-012-0309-8

Wallace, S. L., Robinson, H., Masi, A. T., Decker, J. L., Mccarty, D. J., & Yü, T. S. F. (1977). Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis & Rheumatism, 20(3), 895-900.

Zhu, Y., Pandya, B. J., & Choi, H. K. (2011). Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007–2008. Arthritis & Rheumatology, 63(10), 3136-3141.

Arromdee, E., Michet, C. J., Crowson, C. S., O'Fallon, W. M., & Gabriel, S. E. (2002). Epidemiology of gout: is the incidence rising?. The Journal of rheumatology, 29(11), 2403-2406.

Choi, H. K., Mount, D. B., & Reginato, A. M. (2005). Pathogenesis of gout. Annals of internal medicine, 143(7), 499-516.

Choi, H. K., Atkinson, K., Karlson, E. W., Willett, W., & Curhan, G. (2004). Alcohol intake and risk of incident gout in men: a prospective study. The Lancet, 363(9417), 1277-1281.

Wallace, K. L., Riedel, A. A., Joseph-Ridge, N., & Wortmann, R. (2004). Increasing prevalence of gout and hyperuricemia over 10 years among older adults in a managed care population. The Journal of rheumatology, 31(8), 1582-1587.