Gout is a very painful medical condition. It is a red, tender, hot, swollen joint. The attacks happen most often in the joint at the base of the big toe. It is caused by crystals getting deposited from the blood. This happens when the level of uric acid in the blood is too high. The crystals then stay in joints, tendons, and surrounding tissues.
Inflammatory arthritis happens in about 50% of all cases of gout. The disease may also appear as kidney disease due to urate crystals. People with gout often have more than one attack of gout.
Doctors decide a patient has gout if they find crystals in the joint fluid. Treatment with anti-inflammatory drugs, steroids, or colchicineimproves symptoms. Once an attack goes away, the patient can change his or her lifestyle to reduce levels of uric acid. People who have gout attacks often may take allopurinol or probenecid to prevent symptoms later.
Gout has become more common. It affects approximately one to two percent of people in the West during their lifetimes. Risk factors have been increasing and may be causing the increase in gout. Metabolic syndrome, longer life expectancy, and changes in diet are the most common risk factors. Gout was historically known as “the disease of kings” or “the disease of rich men”.
Gout can present in a number of ways, although the most common is a recurrent attack of intense inflammatory arthritis (a red, tender, hot, swollen joint). Joint pain usually begins over 2–4 hours and during the night. Symptoms occur at night because of the lower body temperature at this time.
High levels of uric acid in the blood over a long period of time (hyperuricemia) may cause other symptoms such as hard, painless deposits of uric acid crystals known as tophi. Extensive tophi may lead to chronic arthritis due to bone erosion.High levels of uric acid in the blood may also cause crystals to form in the kidneys. This causes stone formation followed by urate nephropathy
A very high, abnormal level of uric acid in the blood (hyperuricemia) is the basic cause of gout. Diet and a person’s genes are two of several possible causes of the high levels. Levels can also become high if the body cannot excrete enough urate, the salts of uric acid.
The kinds and amounts of foods people eat cause about 12% of gout. Drinking alcohol or fructose-sweetened drinks, and eating meat and seafood can cause this disease. Injuries and surgery may also start an attack of gout. Recent studies showed that some beliefs about connections between diet and gout were not true. Eating purine-rich vegetables (e.g., beans, peas, lentils, and spinach) large amounts of protein do not contribute to developing gout. Coffee, vitamin C, and dairy products, as well as physical fitness appear to decrease the risk. These things reduce insulin resistance and may reduce cases of gout.
Inherited factors are about 60% responsible for the variability in uric acid level. Two genes called SLC2A9 and ABCG2 are commonly associated with gout. Variations in these genes can almost double the risk of developing this disease.
Gout often happens with other medical problems.Metabolic syndrome happens along with nearly 75% of all cases of gout. Gout often makes these other problems worse or harder to treat: polycythemia, lead poisoning, renal failure, hemolytic anemia, psoriasis, and solid organ transplants. Males have three times the chance of getting gout when the body mass indexis greater than or equal to 35. Frequent lead exposure and lead-contaminated alcohol are risk factors for gout because lead harms the kidney function
Gout is a disorder of purine metabolism, and occurs when its final metabolite, uric acid, crystallizes in the form of monosodium urate. The blood deposits the crystals in joints, on tendons, and in the surrounding tissues. These crystals then trigger a localimmune system inflammatoryreaction. Uricase is required to breakdown uric acid. An evolutionary loss of uricase in humans and higher primates has made this condition so common.
The triggers that cause uric acid to build up in the blood are not well understood. While it may crystallize at normal levels, it is more likely to do so as uric acid levels increase. Other factors believed to be important in triggering an acute episode of arthritis include cool temperatures, rapid changes in uric acid levels, acidosis,articular hydration, and extracellular matrixproteins, such as proteoglycans, collagens, and chondroitin sulfate. The increased critilization at low temperatures partly explains why the joints in the feet are most commonly affected. Rapid changes in uric acid may occur due to a number of factors, including trauma, surgery, chemotherapy,
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