What is gout?

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Gout is a painful form of inflammatory arthritis caused by an accumulation of uric acid crystals in the joints. Uric acid is usually harmless and is made in the body. Most is passed out with the urine and some from the gut. In people with gout the amount of uric acid in the blood builds up. From time to time the level may become too high and tiny grit-like crystals of uric acid may form. The crystals typically collect in a joint. The crystals irritate the tissues in the joint to cause inflammation, swelling and pain – a gout attack.

Untreated, it can lead to permanent joint damage and destruction of tissue. Gout is more common in men over the age of 45, but it can occur in anyone at any age. Factors ranging from a family history of gout, to having other health issues such as high blood pressure, diabetes or kidney disease, can increase risk for developing gout.

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While gout often begins in the big toe, attacks can spread to the feet, ankle, wrists, hands and elbows and cause permanent joint damage. Gout is always accompanied by redness, swelling, and intense, agonizing pain.

Gout has been associated with an overabundance of rich food and drink since ancient times. But until the 20th century, only the wealthy could afford such luxuries. The Greek philosopher-physician Hippocrates called gout the “arthritis of the rich.”

The body converts purines—which occur naturally in the body and come from the foods we eat—into uric acid. Purine-rich foods include most meats and organ meats, most fish and shellfish, and even some vegetables. Wholegrain breads and cereals contain purine too.

Gout can occur whenever there is too much uric acid in the blood and is characterized by sudden, severe attacks of pain, redness and tenderness in joints, often the joint at the base of the big toe.

An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the sheet on it may seem intolerable.

Fortunately, gout is treatable, and there are ways to reduce the risk that gout will recur.

Left untreated, gout can lead to permanent joint damage and other health issues such as kidney stones. Extensive destruction of the joints and large tophi (crystals which form under the skin) can lead to deformities – particularly of the hands and feet – and result in loss of normal use.

While gout is a lifelong condition, it can be managed – or even completely controlled – by sticking with a proper treatment plan that combines the right medication with diet and lifestyle changes.

People with gout should have their uric acid levels tested every six months to be sure it is below 6.0 mg/dL.

Risk Factors include:

  • High-fructose corn syrup is added to many foods and drinks which causes uric acid to go up. Sweetened soft drinks and juices; certain cereals and pastries; ice cream and candy; and processed foods at fast food restaurants often contain high-fructose corn syrup. A diet that’s high in meat and seafood further promotes higher levels of uric acid, which increases your risk of gout. Alcohol consumption, especially of beer, also increases the risk of gout.
  • Someone with a Body Mass Index (BMI) of 30 or higher is considered obese and will produce more uric acid which greatly increases your risk of gout.
  • Medical conditions.Certain diseases and conditions make it more likely that you’ll develop gout. These include untreated high blood pressure and chronic conditions such as diabetes, metabolic syndrome, and heart and kidney diseases.
  • Certain medications.The use of thiazide diuretics — commonly used to treat hypertension — and low-dose aspirin also can increase uric acid levels. So can the use of anti-rejection drugs prescribed for people who have undergone an organ transplant.
  • Family history of gout.If other members of your family have had gout, you’re more likely to develop the disease.
  • Age and sex.Gout occurs more often in men, primarily because women tend to have lower uric acid levels. After menopause, however, women’s uric acid levels approach those of men. Men also are more likely to develop gout earlier — usually between the ages of 30 and 50 — whereas women generally develop signs and symptoms after menopause.
  • Ethnicity – The incidence of gout varies by ethnicity. Some ethnic groups suffer more gout than others. This is genetic. For example, Hispanics and African Americans are more likely to suffer from obesity.
  • Joint Injury – People with previously damaged joints are more likely to get gout.

Recent surgery or trauma. Experiencing recent surgery or trauma has been associated with an increased risk of developing gout.

Gout prevention

During symptom-free periods, these dietary guidelines may help protect against future gout attacks:

  • Keep your fluid intake high.Stay well-hydrated, including plenty of water. Limit how many sweetened beverages you drink, especially those sweetened with high fructose corn syrup.
  • Limit or avoid alcohol.Talk with your doctor about whether any amount or type of alcohol is safe for you. Recent evidence suggests that beer may be particularly likely to increase the risk of gout symptoms, especially in men.
  • Get your protein from low-fat dairy products.Low-fat dairy products may actually have a protective effect against gout, so these are your best-bet protein sources.
  • Limit your intake of meat, fish and poultry.A small amount may be tolerable, but pay close attention to what types — and how much — seem to cause problems for you.
  • Maintain a desirable body weight.Choose portions that allow you to maintain a healthy weight. Losing weight may decrease uric acid levels in your body. But avoid fasting or rapid weight loss, since doing so may temporarily raise uric acid levels. (www.gouteducation.org)
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