Gout

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Gout is a medical condition usually characterized by recurrent attacks of acute inflammatory arthritis — a red, tender, hot, swollen joint. It is caused by elevated levels of uric acid in the blood which crystallize and are deposited in joints, tendons, and surrounding tissues. This can occur for a number of reasons, including diet, genetic predisposition, or underexcretion of urate, the salts of uric acid.

Gout is one of the most painful forms of arthritis and one of the few in which the cause is known. In many cases, inflammation initially develops in the joints of the big toe, a condition called podagra. It also can affect the instep, ankles, heels, knees, wrists, fingers and elbows or present as tophi, kidney stones, or urate nephropathy.

The hallmark symptom of gout is a sudden, severe attack of pain, redness, swelling and tenderness in a joint, often the first toe. Gout typically occurs quickly in only one joint at a time, but symptoms may occur in two or three joints simultaneously. Other symptoms that may occur along with the joint pain include fatigue and a high fever.

Deposits of uric acid, called tophi, can appear as lumps under the skin around the joints and at the rim of the ear. Occasionally, uric acid collects in the kidneys and forms stones.

The disease typically affects men over the age of 30, post-menopausal women, African Americans, people with kidney disease and those who have had an organ transplant. In addition, some families are genetically predisposed to the condition. Gout is strongly associated with obesity, hypertension, hyperlipidemia and diabetes.

Although there is no cure for gout, the majority of patients are able to manage their symptoms with medications. Treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, or colchicine improves symptoms. Once the acute attack has subsided, levels of uric acid are usually lowered via lifestyle changes, and in those with frequent attacks allopurinol or probenicid provide long-term prevention.