Gout

Gout is an ancient and common form of inflammatory arthritis, and is the most common inflammatory arthritis among men. Gout may remit for long periods, followed by flares for days to weeks, or can become chronic.

Gout is a chronic disease caused by an uncontrolled metabolic disorder, hyperuricemia, which leads to deposits of monosodium urate crystals in tissue. Hyperuricemia means too much uric acid in the blood. Uric acid is a made in the body from the break down of purines (found in many foods and in human tissue).

Hyperuricemia is not the same as gout. Asymptomatic hyperuricemia does not need to be treated. Risk factors for gout include being overweight or obese, having hypertension, alcohol intake (beer and spirits more than wine), diuretic use, and a diet rich in meat and seafood. Gout can be viewed as having four stages.

1. First, Asymptomatic (means no symptoms) tissue deposition occurs when people have no overt symptoms of gout, but do have hyperuricemia and the asymptomatic deposition of crystals in tissues. The deposition of crystals, however, is causing damage.
2. Acute flares occur when urate crystals in the joint(s) cause acute inflammation. A flare is characterized by pain, redness, swelling, and warmth lasting days to weeks. Pain may be mild or excruciating. Most initial attacks occur in the lower limbs, typically in the great toe (This is called podagra). About 80% of people with gout do have podagra at some point. Uric acid levels may be normal in about half of patients with an acute flare. Gout may present differently in the elderly, with many joints affected.
3. Intercritical segments (time in between flare ups) occur after an acute flare has subsided, and a person may enter a stage with clinically inactive disease before the next flare. The person with gout continues to have hyperuricemia, which results in continued deposition of urate crystals in tissues and resulting damage. Intercritical segments become shorter as the disease progresses.
4. Chronic gout is characterized by chronic arthritis, with soreness and aching of joints.

People with gout may also get tophi (masses of urate crystals deposited in soft tissue)-usually in cooler areas of the body (e.g., elbows, ears, finger joints). Gout is also associated with an increased risk of kidney stones. The goals of treatment are to end the pain of acute flares, and to prevent future attacks and the formation of tophi and kidney stones. Unlike most types of arthritis, which are chronic, gout is often characterized by painful flares lasting days/weeks followed by long periods without symptoms.

Find practitioners near you who address this condition