Gout

Gout is a form of arthritis (Read about "Arthritis and Rheumatic Diseases") that most often attacks small joints such as the big toe in sudden severe episodes. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) says it accounts for about five percent of all cases of arthritis and results from deposits of crystals of uric acid in joints and/or connective tissue.

If the body increases its production of uric acid or if the kidneys do not eliminate enough uric acid from the body (Read about "The Urinary System"), levels build up (a condition called hyperuricemia). Hyperuricemia may also result when a person eats too many high purine foods. Foods that may cause problems include:

• liver and other organ meats
• dried beans and peas
• anchovies
• gravies
• shellfish
• red meats

The first episode of gout often occurs at night. The pain may be so severe that the patient can't even tolerate the weight of a bed sheet on the affected joint. The Arthritis Foundation says this episode may be triggered by stress, by alcohol, or too many high-purine foods, as well as by joint injury or by chemotherapy. (Read about "Stress" "Cancer Treatments")

According to NIAMS, some things can put you at higher risk of developing gout. These include:

• Family history - Twenty percent of people with gout have a family history of the disease. (Read about "Family Health History")
• Gender and age - It is more common in men than in women and more common in adults than in children. According to NIAMS, women rarely develop gout before menopause. (Read about "Menopause")
• Overweight - Being overweight increases the risk of developing hyperuricemia and gout because there is more tissue available for turnover or breakdown, which leads to excess uric acid production. (Read about "Obesity")
• Alcohol consumption - Drinking too much alcohol can lead to hyperuricemia, because alcohol interferes with the removal of uric acid from the body. (Read about "Alcoholism")
• Diet - Eating too many foods that are rich in purines can cause or aggravate gout in some people.
• Other health problems - Having certain other health problems can increase your risk, including kidney disease, high blood pressure, or hypothyroidism. (Read about "Kidney Disease" "Hypertension: High Blood Pressure" "Thyroid")
• Medications - A number of medications may put people at risk for developing hyperuricemia and gout, including diuretics and salicylate-containing drugs.

In many people, gout initially affects the joints of the big toe (a condition called podagra). But many other joints and areas around the joints can be affected in addition to or instead of the big toe. These include the insteps, ankles, heels, knees, wrists, fingers and elbows. Chalky deposits of uric acid, also known as tophi, can appear as lumps under the skin that surrounds the joints and covers the rim of the ear. Uric acid crystals can also collect in the kidneys and cause kidney stones. (Read about "Kidney Stones")

Treatment options

Doctors can use medicines to treat an acute attack of gout, including:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) - Among the non-steroidal anti-inflammatory drugs (NSAIDs) are aspirin, ibuprofen, indomethacin and naproxen sodium. Many of these drugs are available over-the-counter; however long-term use of these products should never be undertaken without a doctor's advice. NIAMS says common side effects of NSAIDs, including those available over-the-counter, can include stomach upset, heartburn, diarrhea, and fluid retention. (Read about "Heartburn" "Diarrhea" "Gastritis") Some patients also develop liver and kidney inflammation (Read about "The Liver" "Kidney Disease") while taking NSAIDs, making it especially important to stay in close contact with the doctor while taking these medications. (Read about "Medication and Digestion")
• Corticosteroids - Corticosteroids may also be used. These are hormones that can be taken by mouth or given by injection. Prednisone is the corticosteroid most often used to reduce the inflammation of gout. It can be taken orally. The doctor also may inject a corticosteroid into the affected joint to stop pain. According to NIAMS, because frequent injections may cause damage to the cartilage, they should only be done once or twice a year. Long-term corticosteroid use has also been linked to a condition called osteonecrosis in which a portion of bone loses its blood supply and begins to die. (Read about "Osteonecrosis")
• Colchicine - When NSAIDs or corticosteroids do not control symptoms, the doctor may consider using colchicine. This drug is most effective when taken within the first 12 hours of an acute attack.
• Other medications - In addition to medications for acute gout attacks, your doctor may also suggest other medicines to lower the level of uric acid in the blood. These medications are designed to be used over prolonged periods of time to lower blood uric acid levels. They should not be taken during an acute attack. It's also important to take long-term medications with plenty of water to avoid kidney stones. (Read about "Kidney Stones") You should also discuss potential side effects and precautions with your doctor. (Read about "Medicine Safety")

In addition to medication, NIAMS says people with gout are also advised to avoid high-purine foods and alcohol, and to drink plenty of water, which helps to remove uric acid from the body.

Saturnine gout

There is another kind of gout called saturnine gout. It is caused by exposure to lead, which damages the kidneys and affects the removal of uric acid. Acute attacks often occur in the knee, according to the National Institutes of Health.

Historians believe that the ancient Romans often suffered from saturnine gout because they used lead drinking cups and cooking utensils.

Diagnosing saturnine gout involves finding out a person's exposure to lead as well as various tests for lead in the blood. Treatment involves avoiding further lead exposure and treatments to remove lead from the blood. (Read about "Lead Paint Warning")