Gout is a painful and potentially disabling form of arthritis that has been recognized since ancient times. Initial symptoms usually consist of intense episodes of painful swelling in single joints, most often in the feet (especially the big toe). Treatments are available to control most cases of gout, but diagnosing this disorder can be difficult, and treatment plans often have to be tailored for each person.
What Causes Gout?
Gout occurs when excess uric acid (a normal waste product) accumulates in the body, and needle-like 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. Certain foods, such as shellfish and alcohol, may increase uric acid levels and lead to gout attacks. Some medications also can increase uric acid levels. Examples of such medications include moderate-dose aspirin (81 mg used for prevention of heart attack and stroke has minimal effect and generally can be continued), diuretics such as hydrochlorothiazide (Esidrix, Hydro-D), and immunosuppressants used in organ transplantation such as cyclosporine (Neoral, Sandimmune) and tacrolimus (Prograf).
Over 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, painful gout attacks. Uric acid also can deposit in the urinary tract, causing kidney stones.
Who Gets Gout?
Gout afflicts up to three 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. Due to genetic factors, gout tends to run in some families. Gout rarely affects children.