Gout is a condition in which there is too much uric acid in the blood, tissues and urine. Normally, uric acid circulates in the blood until it is passed through the kidneys and excreted via urine. In gout, uric acid accumulates and eventually crystallizes, forming needle-like crystals in the joint and causing severe pain and inflammation. Clinically, an episode of gout is associated with sudden severe pain, tenderness, redness, heat and swelling. Pain is sometimes so excruciating that even the light weight of a bed sheet on an affected joint is unbearable.
The most common site for gout is the big toe but it also affects other joints such as the knees, ankles, feet, hands, fingers, wrists and elbows. More advanced gout may eventually affect the shoulders, hips or spine, although this is uncommon.
There may be a link between race and gout and between hypertension and gout: one study to assess wheather race is a predisposing factor included baseline hypertension in the evaluation. Researchers examined the records of two long-term studies in male medical students - one in 352 blacks from Meharry Medical College, the othr of 571 whites from Johns Hopkins University School of Medicine.
The outcome: 70% more of the black men had gout than did the white men. Socioeconomic factors were not considered relevant since the two groups had comparable levels of education and professional status, suggestiong similar lifestyles. Additionally, these investigators considered the black men's greater risk for gout to be directly related to their increased risk for hypertension because the incidence of gout in the two groups was nearly identical among hypertensives.
The disease affects nearly 2.1 million Americans and more than 80% of them are men. Gout has often been associated with affluence and referred to as the "rich man's disease" - the gout patient is depicted as a bloated middle-aged man sitting in a stuffed chair, with one leg resting on an ottoman while he lustily consumes red meat and red wine.
Obesity, in particular, seems to be linked with hight blood levels of uric acid. Also, uric acid is a by-product of certain foods, so gout can be related to diet. Purine-rich foods should be avoided or kept at a minimum, e.g., anchovies, asparagus, herring, mushrooms, sardines, mussels, and sweetbreads, Drinking alcohol and crash diets may bring on an episode, as might overeating, stress, surgery or joint injury. Thus the precise cause of gout is uncertain.
Drug treatment is generally aimed at relieving pain, Decreasing inflammation, preventing future attacks and/or preventing joint damage. Common drugs to teat acute episodes include colchicine (which has been used for over 2,000 years); NSAIDS (like ibuprofen, naproxen, or ketoprofen), corticosteroids, and ACTH. Allopurinol is used to reduce the rate of uric acid production, while probenecid and sulfinpyrazone may be used to lower the levels of uric acid in the blood; they help dissolve tophi (deposits that look like lumps under the skin) and prevent uric acid deposits in the joints.
For more detailed information about gout and its teatment, contact the Arthritis Foundation at 1-800-283-7800.
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