Gout: A Success Story
Gout has caused much human suffering and has been studied intently by physicians, since the days of Hippocrates. Once known as "the disease of kings" and "the king of diseases", gout was recognized as one of the leading causes of painful, disabling, chronic arthritis. With advances in research, gout has been all but conquered. People who continue to suffer with gout often are found to be unknowledgeable about new and effective treatments.
What Causes Gout?
Excess uric acid in the body is recognized as the cause of gout. The excess can be caused by:
- increase in production of uric acid by the body.
- by under-elimination of uric acid by the kidneys.
- by increased intake of foods which contain purines which are metabolized to uric acid in the body.
Certain meats, seafood, dried peas, and beans are very high in purines. Alcohol also can increase uric acid levels and precipitate gout attacks.
Elevated levels of uric acid in the blood may result in deposits around the joints (sharp needle-like crystals of monosodium urate). Uric acid also can collect under the skin as tophi, or in the urinary tract as kidney stones.
The definitive diagnosis of gout depends on finding uric acid crystals in joint fluid during an acute gout attack. Uric acid levels in blood alone can be misleading, as they can be transiently normal or low. It should also be mentioned that uric acid levels often are elevated in people who do not have gout.
Gout usually strikes a single joint suddenly and violently. The episode begins with redness, heat, swelling, and pain - the classic signs of inflammation. Less commonly, gout can develop more slowly, involving multiple joints, resembling rheumatoid arthritis. The big toe is commonly affected first with distinct pain, called podagra.
Colchicine has been the standard treatment for acute gout since the 1800s. Side effects of colchicine include nausea, vomiting, and diarrhea. When administered as an I.V. the side effects are less common. Because the side effects of colchicine can be problematic, NSAIDs are used for the treatment of acute attacks of gout. Indomethacin is the most commonly prescribed NSAID for gout, but it too must be watched for toxicity. Aspirin and aspirin-containing products should not be used during acute gout attacks.
For patients who have had multiple gout attacks or developed tophi or kidney stones, normalizing uric acid levels should be considered. Probenecid is a drug which helps the kidneys eliminate uric acid, and allopurinol is a drug which blocks production of uric acid by the body. The drug of choice is determined by the amount of uric acid in the urine.
- Gout affects approximately 840 out of 100,000 people.
- Gout occurs more commonly and at a younger age in men.
- Gout is associated with obesity, hypertension, hyperlipidemia, and diabetes.
In nearly all cases, gout should be well-controlled, with proper treatment. Gout is considered one of modern medicine's success stories.
Gout: ACR Fact Sheets
Gout: The Duke University Medical Center Book Of Arthritis