The Causes and Effects Associated with Gout

Gout, attributed in the middle ages to a life of gluttony (in fact, it was referred to as the “disease of kings”), is a painful arthritis which develops in patients with a high burden of uric acid (or urate).

Typified by “podagra”, an acute inflammation of the great toe, gout can affect other joints as well as the kidneys. It tends to be recurrent over years, with the second episode usually occurring within two years. In its most severe and untreated form, gout can lead to renal failure. Besides obesity, gout is associated with hypertension and diabetes so control of these conditions is part of the basic management of gout.

The condition is more common in middle age, with an increased prevalence in patients with obesity, hypertension, alcohol and excessive intake of meat and certain seafoods. All of these conditions are cause by a buildup of too much uric acid in the body. Uric acid, a natural body constituent, normally dissolves in the blood and is excreted by the kidneys.  However, if the body makes excessive urate, the kidneys excrete too little, or the diet contains too much, levels can build up.

Gout has three phases; acute, intercritical and chronic.  Acute gouty arthritis is very painful, develops over 24 hours, and is associated with redness, swelling and tenderness of the joint. In addition to the big toe, the knee is also often affected.  Infection of the joint may present in the same way and is often the main diagnostic challenge. 

The diagnosis is often based upon aspiration of joint fluid with a small needle, and microscopic examination for the characteristic gouty crystals.  Treatments include anti-inflammatory drugs (such as indomethacin) and steroids (by mouth or by injection).

Intercritical gout is the time between attacks, and is the time during which your physician will determine what therapy, if any, is most appropriate for your long-term use. Chronic gout is seen in patients who have attacks spread out over years and have widespread urate deposition in tissues.  In the kidney this may manifest as renal failure or kidney stones. Some patients develop tophi, nodules or large lumps in joints and cartilage.

Dietary management is a cornerstone of therapy. If you are obese, weigh loss is essential. It is recommended to eat less red meat, seafood, beer and hard alcohol, and items with high fructose corn syrup. Increased ingestion of low fat dairy products, complex carbohydrates (whole grains, brown rice, oats and beans), and vitamin C is encouraged.

For more information check out the website of the American College of Rheumatology.