Gout
Gout (/ɡaʊt/ GOWT) is a form of inflammatory arthritis characterized by recurrent attacks of a red, tender, hot and swollen joint, caused by the deposition of needle-like crystals of uric acid known as monosodium urate crystals. Pain typically comes on rapidly, reaching maximal intensity in less than 12 hours. The joint at the base of the big toe is affected (Podagra) in about half of cases. It may also result in tophi, kidney stones, or kidney damage.
| Gout | |
|---|---|
| Other names | Arthritis uratica, or Podagra when of the foot |
| Video summary (script). Leading with The Gout (James Gillray, 1799), which depicts the pain of the artist's gout as a demon or dragon. | |
| Specialty | Rheumatology |
| Symptoms | Joint pain, swelling, and redness |
| Usual onset | Older males, post-menopausal women |
| Causes | Uric acid |
| Risk factors | Diet high in meat or beer, being overweight, genetics |
| Differential diagnosis | Joint infection, rheumatoid arthritis, pseudogout, others |
| Prevention | Weight loss, abstinence from drinking alcohol, allopurinol |
| Treatment | NSAIDs, glucocorticoids, colchicine |
| Frequency | 1–2% (developed world) |
Gout is due to persistently elevated levels of uric acid (urate) in the blood (hyperuricemia). This occurs from a combination of diet, other health problems, and genetic factors. At high levels, uric acid crystallizes and the crystals deposit in joints, tendons, and surrounding tissues, resulting in an attack of gout. Gout occurs more commonly in those who regularly drink beer or sugar-sweetened beverages; eat foods that are high in purines such as liver, shellfish, or anchovies; or are overweight. Diagnosis of gout may be confirmed by the presence of crystals in the joint fluid or in a deposit outside the joint. Blood uric acid levels may be normal during an attack.
Treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, or colchicine improves symptoms. Once the acute attack subsides, levels of uric acid can be lowered via lifestyle changes and in those with frequent attacks, allopurinol or probenecid provides long-term prevention. Taking vitamin C and having a diet high in low-fat dairy products may be preventive.
Gout affects about 1–2% of adults in the developed world at some point in their lives. It has become more common in recent decades. This is believed to be due to increasing risk factors in the population, such as metabolic syndrome, longer life expectancy, and changes in diet. Older males are most commonly affected. Gout was historically known as "the disease of kings" or "rich man's disease". It has been recognized at least since the time of the ancient Egyptians.