How Much Do You Know About Gout?

The Egyptians were the first to identify gout over 4,000 years ago, and the Greek physician Hippocrates, “the father of medicine,” wrote bout it. Hippocrates even noted the connection between the intense and temporary joint pain of gout and the consumption of alcohol and rich foods.

Understanding gout has changed in more recent times and once considered a condition of the wealthy, it was known as the “disease of kings,” gout is now known to affect everyone in all walks of life. Food and drink do play a role in gout, but there are also several other risk factors including genes. And according to the American College of Rheumatology, gout affects up to 3 million Americans, making it one of the most common types of arthritis.

If you have high uric acid levels in your blood then the stage is set for gout. Uric acid is the byproduct of the body's breakdown of substances called purines. Purines are found naturally in the body and are also present in high levels in certain foods. When the purines are broken down, the results are uric acid and then that is carried through the bloodstream to the kidneys and then flushed out of the body through your urine.

There are some people who have high levels of uric acid that builds up in the bloodstream, a condition that's called hyperuricemia, that may be the result of an excess of purines in the body, caused by a purine rich diet or because the body produces too many purines. More commonly, it is the result of the kidneys' inability to remove enough uric acid from the blood. There are times when it's a combination of the two causes. Also, there are some people, not all, with hyperuricemia, that have the uric acid in the blood form into sharp, needle-like crystals that can collect in a joint and this sets off an inflammatory reaction, that causes pain, swelling, and redness, this is gout.

Gout usually follows a pattern of “attacks” followed by periods with few or no symptoms. Gout attacks usually come on suddenly, often at night, with intense pain and inflammation in a joint or joints. Without treatment, the pain usually lasts 5 to 10 days and then subsides and you may not have another attack for several years. After several attacks, the episodes of gout will often become more frequent and longer lasting.

The big toe joint is the most common place for gout and is usually the first joint affected, while other joints can also be affected, like other joints in the foot and the ankle, knee, elbow and with more advanced gout the hands and writs may be involved. Gout can affect more than the joints, crystals can collect in the urinary tract and kidney stones can form.

The diagnosis of gout can usually be made with a high degree of accuracy using a needle to take a fluid sample from an affected joint and then examine the fluid sample under a microscope for uric acid crystals. If this test isn't available, the doctor will consider the symptoms such as hyperuricemia (blood test can establish this) and sudden and intense pain, especially in the joint of the big toe. Some people with gout will have a lump of uric acid crystals called a tophus that may form near the affected joint and is usually associated with advanced gout.

Gout is more common in men, in the age group between 40 and 60, but women will develop gout at increasing rates after menopause.

An increase in uric acid levels in the blood can be found in foods high in purines and raise the risk of a gout attack. Seafood like shellfish, sardines, herring, and anchovies are high in purines and so are red meats and organ meats like liver, kidney, and sweetbread. All alcohol causes the kidneys to excrete less uric acid, thereby raising uric acid levels in the blood, but beer, having this affect also is high in purines.

Diet isn't the only factor that influences whether or not you develop gout or have another attack. There are people who eat foods that are high in purines and never get gout, while others can eat these foods and still get gout.

Type 2 diabetes, high cholesterol levels, and high blood pressure have all been found to raise the risk of gout, although, it's not clear why they do. While rheumatoid arthritis and other types of arthritis don't have the same effect. Also, diuretics, or “water pills,” as well as other medicines, including cyclosporine, Neoral, Sandimmune, and moderate doses of aspirin, can increase the risk of gout, while low dose aspirin that is taken to reduce heart attacks and strokes, are safe for people with gout.

For those people who have gout attacks, it's important to have treatments to reduce the blood levels of uric acid because as the uric acid levels go down in the blood, the uric acid crystals in the joints and tophi are reabsorbed back into the body and the symptoms of gout decrease or go away completely. But, if you leave your gout untreated, it can cause serious problems in the joints and after a time of intermittent attacks, gout can become chronic, causing pain even between attacks and it can damage the structure of the joint. Chronic gout can damage the kidneys as well.