Gout
What is it?
Gout (gowt) occurs when needle-shaped monosodium urate crystals build up in joints and tissues. The presence of these crystals can cause
- recurrent attacks of painful joint inflammation (called gouty arthritis)
- the formation of tophi, or lumps of collected crystals under the skin, in the joints and in bone.
- kidney stones
- impaired kidney function (called gouty nephropathy or urate nephropathy).
Gout is a controllable disease that, with proper treatment, need not lead to any long-term effects.
Monosodium urate crystals form when there is too much uric acid (also called urate) in the blood -- a metabolic disorder called hyperuricemia. Having this disorder may lead to the development of gout. Uric acid is produced when foods containing purines (chemical compounds that are building blocks in the construction of DNA and RNA), such as organ meats, seafood (especially anchovies), and gravies, are broken down and when purine nucleotides (DNA and RNA building blocks) are recycled in the body. High uric acid production, low uric acid excretion, or a combination of both can result in hyperuricemia and gout.
The course of classic gout passes through three distinct stages: asymptomatic hyperuricemia, acute intermittent gout, and chronic tophaceous gout.
- Asymptomatic hyperuricemia is defined as having high uric acid levels in the blood without having any symptoms of gout. The vast majority of people with hyperuricemia are asymptomatic and may never develop gout.
- Acute intermittent gout is the stage of disease in which you will have one joint that becomes intensely painful, swollen and hot. This acute bout of arthritis will last for two weeks or less without treatment, and less than that with treatment. After the attack subsides, you will be symptom-free for weeks, months or even years until the next attack.
- If your gout goes untreated for several years, it may enter the third stage, chronic tophaceous gout. In this stage, the affected joints will be uncomfortable and swollen all the time with periods of severe inflammation more frequently than before. More than one joint may become involved in the acute attacks. Monosodium urate crystals may collect to form tophi, or lumps under the skin. Kidney stones may also develop during this stage.
Gout is one of the most treatable forms of arthritis, and with proper treatment, you need not have any long-term consequences. Medications are available to relieve the pain and inflammation of acute bouts of gouty arthritis. For long-term care, you may need to take medications to treat the underlying metabolic disorder along with making such lifestyle changes as avoiding alcohol (primarily beer) and foods high in purines and increasing intake of dairy foods. Although those lifestyle changes may help prevent future attacks, reducing your purine intake usually results in only a modest reduction in uric acid levels.
