Gout is a disease that results from an overload of uric acid in the body. This overload of uric acid leads to the formation of tiny crystals that deposit in tissues of the body, especially the joints. When crystals form in the joints, it causes recurring attacks of joint inflammation (arthritis). Gout is a complex form of arthritis characterized by sudden, severe attacks of pain, redness and tenderness in joints, often the joint at the base of the big toe.
It is considered a chronic and progressive disease. Chronic gout can also lead to deposits of hard lumps of uric acid in the tissues, particularly in and around the joints and may cause joint destruction, decreased kidney function, kidney stones and blockage of the kidney-filtering tubules with uric acid crystals, leading to kidney failure.
Gout can affect anyone. Men are more likely to get gout, but women become increasingly susceptible to it after menopause. An acute attack of gout can wake you up in the middle of the night feeling like your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the sheet on it seems intolerable. It is treatable, and there are ways to reduce the risk of recurrence.
The signs and symptoms of gout are almost always acute, occurring suddenly, often at night and without warning. They include:
• Inflammation and redness – the affected joint or joints become swollen, tender and red.
• Lingering discomfort – after the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.
• Intense joint pain – gout usually affects the large joint of your big toe, but it can occur in your feet, ankles, knees, hands and wrists. The pain is likely to be most severe within the first 12 to 24 hours after it begins.
Gout occurs when urate crystals accumulate around your joint, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood. Your body produces uric acid when it breaks down purines substances that are found naturally in your body as well as in certain foods.
Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes your body either produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needle-like urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.
You’re more likely to develop gout if you have high levels of uric acid in your body. Factors that increase the uric acid level in your body include:
• Lifestyle factors. Choices you make in your everyday life may increase your risk of gout. Excessive alcohol use — generally more than two drinks a day for men and more than one for women — increases the risk of gout.
• Medical conditions. Certain diseases and conditions make it more likely that you’ll develop gout. These include untreated high blood pressure (hypertension) and chronic conditions such as diabetes, high levels of fat and cholesterol in the blood (hyperlipidemia), and narrowing of the arteries (arteriosclerosis).
• Certain medications. The use of thiazide diuretics — commonly used to treat hypertension — and low-dose aspirin also can increase uric acid levels. So can the use of anti-rejection drugs prescribed for people who have undergone an organ transplant.
• Family history of gout. If other members of your family have had gout, you’re more likely to develop the disease.
• Age and sex. Gout occurs more often in men than it does in women, primarily because women tend to have lower uric acid levels than men do. After menopause, however, women’s uric acid levels approach those of men. Men also are more likely to develop gout earlier — usually between the ages of 40 and 50 — whereas women generally develop signs and symptoms after menopause.
Tests and diagnosis
Tests to help diagnose gout may include:
• Joint fluid test. Your doctor may use a needle to draw fluid from your affected joint. When examined under the microscope, your joint fluid may reveal urate crystals.
• Blood test. Your doctor may recommend a blood test to measure the uric acid level in your blood. Blood test results can be misleading, though. Some people have high uric acid levels, but never experience gout. And some people have signs and symptoms of gout, but don’t have unusual levels of uric acid in their blood.
Treatments and drugs
Treatment for gout usually involves medications. You and your health provider would select the best treatment option to suit your particular problems.
Medications are prescribed to:
• Treat acute gout attacks and prevent future attacks
• Reduce the risk of gout complications, such as the deposits of urate crystals that cause nodules to form under the skin (tophi).
Drugs used to treat acute attacks and prevent future attacks include:
• Anti-inflammatory drugs
• Medication that blocks uric acid production
• Medication that improves uric acid removal
If you experience several gout attacks each year or if your gout attacks are less frequent but particularly painful, your doctor may recommend medication to reduce your risk of future gout attacks and of gout-related complications.
During gout free periods, dietary restrictions may help protect against future gout attacks. Some are limiting or avoiding your alcohol intake, having a high fluid intake, following a balanced diet, and maintain a healthy weight.
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