Gout
What is Gout?
Known as “the disease of kings and the king of diseases,” gout has been studied by physicians and has caused suffering in countless humans at least since the days of Hippocrates. Formerly a leading cause of painful and disabling chronic arthritis, gout has been all but conquered by advances in research. Unfortunately, many people with gout continue to suffer because knowledge of effective treatments has been slow to spread to patients and their physicians.
Cause
Gout is caused by an excess of uric acid in the body. This excess can be caused by an increase in production by the body, by under-elimination of uric acid by the kidneys or by increased intake of foods containing purines which are metabolized to uric acid in the body. Certain meats, seafood, dried peas and beans are particularly high in purines. Alcoholic beverages may also significantly increase uric acid levels and precipitate gout attacks.
With time, elevated levels of uric acid in the blood may lead to deposits around joints. Eventually, the uric acid may form needle-like crystals in joints, leading to acute gout attacks. Uric acid may also collect under the skin as tophi or in the urinary tract as kidney stones.
Diagnosis
Since several other kinds of arthritis can mimic a gout attack, and since treatment is specific to gout, proper diagnosis is essential. The definitive diagnosis of gout is dependent on finding uric acid crystals in the joint fluid during an acute attack. However, uric acid levels in the blood alone are often misleading and may be transiently normal or even low. Additionally, uric acid levels are often elevated in individuals without gout.
Health Impact
- Gout afflicts an estimated 840 out of 100,000 people.
- Gout and its complications occur more commonly and at a younger age in males.
- Gout is strongly associated with obesity, hypertension, hyperlipidemia and diabetes.
Treatment
Since the 1800s, colchicine has been the standard treatment for acute gout. While colchicine is very effective, it often causes nausea, vomiting and diarrhea. These side effects are uncommon when this drug is given intravenously. Because of the unpleasant side effects of colchicine, non-steroidal anti-inflammatory drugs (NSAIDs) have become the treatment of choice for most acute attacks of gout. The NSAID that is most widely used to treat acute gout is indomethacin. NSAIDs may also have significant toxicity, but if used for the short-term, are generally well tolerated. Aspirin and aspirin-containing products should be avoided during acute attacks.
Therapy directed at normalizing uric acid levels in the blood should be considered for patients who have had multiple gout attacks or have developed tophi or kidney stones.