What Is Gout?
Without warning and, for some reason, in the middle of the night, gout strikes — an intense pain in a joint, most often the big toe, but sometimes other joints, including knees, ankles, elbows, thumbs, or fingers.
Attacks of gout can be unexpected and excruciatingly painful. With prompt treatment, the pain and inflammation usually disappear after a few days, but they may recur at any time.
More than 8 million Americans suffer from gout. Gout occurs more often in men than in women. Men usually develop it between the ages of 30 and 50. Women are more prone to gout after menopause, and it is rare in children and young adults. Men who are overweight or suffering from high blood pressure are particularly prone to gout, especially if they are taking thiazide diuretics (water pills).
Gout is actually a form of arthritis. It is the body’s reaction to irritating crystal deposits in the joints. The pain can be intense, but treatment usually works very well. Mild cases may be controlled by diet alone. Recurring attacks of gout may require long-term medication to prevent damage to bone and cartilage and deterioration of the kidneys.
Chronic gout sufferers may feel tiny, hard lumps accumulating over time in the soft flesh of areas such as the hands, elbows, feet, or earlobes. These deposits, called tophi, are concentrations of uric acid crystals and can cause pain and stiffness over time. If similar deposits form in the kidneys, they can lead to painful and potentially dangerous kidney stones.
What Causes Gout?
An excess of uric acid in the blood brings on gout. Uric acid comes from two places — produced by the body and from the diet. Any extra uric acid usually filters through the kidneys and gets passed in urine. If the body produces too much uric acid or fails to excrete it in the urine, crystals of monosodium urate form in the joints and tendons. These crystals cause intense inflammation leading to pain swelling and redness.
What exactly causes gout to occur when it does? The most common factor that increases your chance of gout and gout attacks is excess consumption of alcohol, especially beer. It used to be known as “the disease of kings" since it was mainly seen in wealthy men who drank and ate too much. Now we know it can occur in anyone and can be associated with injury or surgical procedures, hospitalizations, periods of stress, or reactions to diets high in meat and seafood, and certain drugs such as antibiotics. Gout may also occur in the presence of some tumors or cancers. There is also a relation between gout and kidney disorders, enzyme deficiencies, and lead poisoning. Gout may also accompany psoriasis and is common in patients with transplanted organs due to medications that are often needed. Susceptibility to gout is often inherited and is often associated with other common illnesses such as high blood pressure, diabetes, and obesity. Repeat attacks of gout are common if the body’s uric acid level is not kept under control.
Pseudogout is a similar but generally less painful condition caused by calcium pyrophosphate crystals in the joints. While it can affect the large toe, it is more commonly seen in larger joints such as the knee, wrist, or ankle. More common after age 60 in both sexes, pseudogout is treated with anti-inflammatory agents.