Gout is a painful and potentially disabling form of arthritis that has been recognized since ancient times. Gout is sometimes referred to as the “disease of kings” because it has long been associated erroneously with the kind of overindulgence in food and wine only the rich and powerful could afford. Initial symptoms usually consist of intense episodes of painful swelling in single joints, most often in the feet (especially the big toe).
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Explore This IssueMarch 2009
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Gout afflicts up to 3 million Americans. This condition and its complications occur more often in men, women after menopause, and people with kidney disease. Gout is strongly associated with obesity, hypertension, hyperlipidemia, and diabetes. Because of genetic factors, gout tends to run in some families.
Gout occurs when excess uric acid (a normal waste product) accumulates in the body and crystals deposit in the joints. This may happen because either uric acid production increases or, more often, the kidneys are unable to remove uric acid from the body adequately. According to patient–fact sheet writer H. Ralph Schumacher, MD, “certain foods, such as shellfish and alcohol, as well as some medications, like moderate-dose aspirin and diuretics, may increase uric acid levels and lead to gout attacks.” With time, increased uric acid levels in the blood may lead to deposits of monosodium urate crystals in and around the joints. These crystals can attract white blood cells, leading to severe gout attacks.
Several other kinds of arthritis can mimic gout, so proper diagnosis is essential. Gout is suspected when a patient experiences joint swelling and intense pain followed, at least at first, by pain-free periods between attacks. Initial gout attacks often occur at night. A correct diagnosis may depend on finding the characteristic crystals by extracting fluid from an affected joint and examining that fluid under a microscope to determine whether monosodium urate crystals are present.
“Although treatments are now available to control most cases of gout, diagnosing this disorder can be difficult. What works well for one person may not work as well for another, so decisions about when to start treatment and what drugs to use have to be tailored for each patient,” says Dr. Schumacher. In almost all cases, it is possible to successfully treat gout so that the patient experiences a gradual ending of attacks. People with chronic gout often require lifetime treatment with drugs to lower uric acid levels. However, lifestyle changes such as weight control, limiting alcohol consumption, and limiting meals with meats and fish rich in purines can also be helpful in controlling this lifetime disease.