Gout is a disease caused by too much uric acid in your body. Uric acid can be deposited in various sites in the body including joints. Too much uric acid may not cause symptoms for years. But after time, the accumulation of deposits may cause painful joint inflammation (arthritis).
Most people who have gout are middle-aged men, but it can occur at any age. Only 5 to 10% of cases of gout occur in women, usually after menopause.
The pain of acute gout is often extreme, especially in the first few episodes. The initial episodes frequently involve a single joint, usually the big toe. This can interrupt sleep, prevent walking and interfere with work and leisure. With the passage of time, recurrent acute arthritis may involve multiple sites including the knees and the joints in the upper extremity.
When recurrent acute gout goes untreated and when there is a failure to eradicate causative factors the condition may evolve. The patient may no longer just have sporadic arthritis attacks of only one joint but may experience repeated attacks in multiple joints with increasing frequency or even have persistent low grade joint inflammation and joint deformity. There may even be deposition of urate crystals to form visible tophi, or lumpy deposits under the skin. Swelling and deformity then become the characteristic signs, but without the intense inflammation.
Your physician may deem it necessary to aspirate fluid from an inflamed joint to demonstrate that the urate crystals are causing the problem. Also, blood and/or urine tests may be indicated to assess the degree of increased uric acid in your body. Finally, standard x-rays may be necessary to determine if joint or soft tissue damage has occurred.
The principle goal of treatment includes treating the acute attacks early and effectively. It is also important to correct factors that may contribute to increased uric acid. These include decreasing excessive alcohol use, correcting obesity or substituting diuretic therapy with another hypertension medicine. Also, ingestion of foods high in purines (precursors of uric acid), such as red meat, wine and beer need to be decreased. Finally, medications to decrease the uric acid pool in the body can be instituted.
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