Gout is a condition that was first identified as early as 2640 BC by the ancient Egyptians. In the 5th Century BC, Hippocrates, the legendary Greek physician, referred to gout as "unwalkable disease," noting links between the condition and certain lifestyle habits.1
Despite its long history, gout remains a major public health concern, with an increasing number of people suffering from what can be an extremely painful condition. Gout has also been related to an increased incidence of cardiovascular and metabolic disease.11
This complex form of arthritis is characterized by the onset of sudden and severe pains. A veteran visiting a VA Hospital in Birmingham, AL, said, "I've been shot, beat up, stabbed and thrown out of a helicopter, but none of that compared to the gout."1
Fortunately, gout is treatable and there are preventative measures that can be taken to reduce the risk of developing the painful condition.2
Contents of this article:
You will also see introductions at the end of some sections to any recent developments that have been covered by MNT's news stories. Also look out for links to information about related conditions.
Fast facts on gout
Here are some key points about gout. More detail and supporting information is in the main article.
- Gout is a form of arthritis caused by excess uric acid in the bloodstream.
- The symptoms of gout are due to the formation of uric acid crystals in the joints.
- Gout most commonly affects the joint in the base of the big toe.
- Gout attacks often occur without warning in the middle of the night.
- There are four stages of gout varying in clinical severity.
- Not all people with hyperuricemia develop gout, and not all gout attacks occur when a person has hyperuricemia.
- Advanced cases of gout can lead to the formation of kidney stones.
- Doctors often use joint fluid tests when testing for gout.
- Most gout cases are treated with specific medication.
- Avoiding animal-derived foods with a high purine content is a good preventative measure to take to avoid gout (purine-rich plant foods do not seem to be related to gout attacks).
What is gout?2-4
Gout is a common form of inflammatory arthritis - a condition affecting the joints and musculoskeletal system. It is the most common form of inflammatory arthritis in men, and although it is more likely to affect men, women become more susceptible to it after the menopause.
Gout commonly affects the base of the big toe. When affecting this area, the condition can also be referred to as podagra.
The condition is characterized by sudden and severe pains, redness and tenderness in the joints, most commonly in the base of the big toe. When affecting the big toe, gout can also be referred to as podagra.
These symptoms occur when uric acid, a product of ordinary metabolic processes, is deposited in the form of needle-like crystals in tissues and fluids within the body. Chalky deposits of uric acid known as tophi can also form as lumps under the skin surrounding the joints. Uric acid crystals can also collect in the kidneys, sometimes resulting in kidney stones.
At its most disabling, gout can cause permanent damage to joints and the kidneys. However, it normally takes a long period, around 10 years, without any proper treatment for the disease to reach this advanced stage, however.
The Centers for Disease Control and Prevention (CDC) report that 2.6 million Americans were affected by gout in 2005 and that this figure is projected to rise to 3.6 million by 2025.1
What causes gout?3-7
Gout is caused initially by an excess of uric acid in the blood (hyperuricemia). Uric acid is produced in the body through the breakdown of purines - specific chemical compounds that are found in high amounts in certain foods such as meat, poultry and seafood.
Normally, uric acid is dissolved in the blood and is excreted from the body in urine via the kidneys. If too much uric acid is produced or not enough is excreted then it can build up and form the needle-like crystals that trigger inflammation and pain in the joints and surrounding tissue.
There are a number of factors that can increase the likelihood of hyperuricemia, and therefore gout:
- Age and gender: men produce more uric acid than women, though women's levels of uric acid approach those of men after the menopause
- Genetics: a family history of gout increases the likelihood of the condition developing
- Lifestyle choices: alcohol consumption interferes with the removal of uric acid from the body. Eating a high-purine diet also increases the amount of uric acid in the body
- Lead exposure: chronic lead exposure has been linked to some cases of gout
- Medications: certain medications can increase the levels of uric acid in the body; these include some diuretics and drugs containing salicylate
- Weight: being overweight increases the risk of gout as there is more turnover of body tissue, which means more production of uric acid as a metabolic waste product. Higher levels of body fat also increase levels of systemic inflammation as fat cells produce pro-inflammatory cytokines
- Other health problems: renal insufficiency and other kidney problems can reduce the body's ability to efficiently remove waste products, leading to elevated uric acid levels. Other conditions associated with gout include high blood pressure (hypertension), diabetes and hypothyroidism.
Recent developments on gout causes from MNT news
Researchers from the UK's University of Nottingham and colleagues conducted a new study of the population of Taiwan, where there is a high rate of gout, and found that the condition clusters in families.
Foods rich in purines, particularly those found in meat and seafood, quintuple the immediate risk of a gout flare-up, according to research published online in the Annals of the Rheumatic Diseases.
On the next page we look at the signs and symptoms of gout, how it is diagnosed and the available treatments for gout.