Gout has traditionally been called the "disease of kings and the king of diseases." It has been known for several thousand years. It was most common in those who had the wealth and leisure to be sedentary, eat a rich diet, and drink substantial amounts of alcohol. Kings, nobles, and those who were wealthy were most likely to fit those categories. Now, of course, you don't have to be rich to get gout. Everyone has a chance!
Gout occurs when uric acid, normally dissolved in the blood and excreted through the kidneys, builds up, and forms crystals. The pain of gout results when these needle-like crystals of uric acid are deposited in the joints.
Gout is one of the few types of arthritis that is more common in men than in women. Most commonly, men first experience symptoms in their 40s or 50s.
Common Symptoms
- Symptoms can first appear as painful attacks during the night. Most commonly the severe pain is in the big toe and nearby joints.
- Swelling and pain can increase for 12 hours or more and usually subside within three days to a week.
- The affected joint becomes swollen and red.
What Leads to Gout?
A number of behaviors or conditions are associated with gout, although the exact causes are unknown.
- A high level of uric acid in the body is present in most cases of gout.
- Being overweight is common.
- High alcohol intake is associated with gout.
- Intake of foods high in purines increases uric acid in the body. This includes eating liver, kidney, tripe, tongue, shellfish, and scallops.
- Some drugs and medications increase risk. Diuretics, niacin, salicylates, and others. Ask your doctor.
- Long-term kidney disease can cause gout.
- Trauma to a joint is a common symptom.
- There seems to be a genetic link for some cases of gout.
The Progression of the Disease
There are four stages in the development of gout. It can be diagnosed, treated, and stopped in the early stages.
- Stage One – Asymptomatic hyperuricemia (high uric acid level in the blood but no symptoms)
As uric acid levels increase, so does the risk of having an attack.
- Stage Two – Acute gout (acute gouty arthritis)
Uric acid crystals are deposited in joint spaces. There is pain and swelling. Painful attacks may occur at night, but they can happen at any time.
- Stage Three – Interval gout
This is the period between attacks. The symptoms go away and joints function normally. This is not a cure and, without treatment, future attacks are likely.
- Stage Four – Chronic Tophaceous gout
This is the disabling stage. It often takes ten years or more to develop. Permanent damage is done to joints and often the kidneys. With treatment at earlier stages, most people will not progress to this stage.
Diagnosis and Treatment
Because of the location and type of symptoms, diagnosis is easier than for some other types of arthritis. Blood tests can identify high levels of uric acid, and fluid taken from swollen joints can show uric acid crystals. In later stages, X-rays can show joint damage.
Early treatment can prevent attacks and joint damage.
- The most common treatment is high doses of NSAIDs (to reduce swelling) along with injections of corticosteroid drugs into the affected joint.
- Medications can help increase the excretion of uric acid and inhibit the production of uric acid.
- Avoid drugs that decrease uric acid excretion.
- Maintain a healthy weight, and lose weight if necessary.
- Reduce alcohol intake.
- Increase fluid intake so there will be about two quarts of urine output each day.
- Bed rest is often recommended during attacks, but physical activity is important whenever possible.
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