by Christobel Rajesh

Created on: October 22, 2008

Gout is a heterogeneous group of conditions related to a genetic defect of purine metabolism. This condition is characterized with hyperuricemia, where there is either over secretion of uric acid, or a renal defect resulting in decreased excretion of uric acid, or a combination of both. Gout is a condition that is associated with rheumatic arthritis. It generally affects men over 30 years of age. Women are less affected than men.

There are different reasons stated for gout to occur. Some of the causes are listed as follows:

1. Severe dieting or starvation.
2. Excessive intake of foods that are rich in purines (shellfish, organ meats).
3. Heredity.
4. Secondary to other diseases like leukemia, multiple myeloma, some type of anemias, psoriasis.
5. Side effects of certain medication like diuretics (thiazides, furosemide) ethanol, and some salicylates that contributes to uric acid under excretion.

Attacks of gout seem to be related to sudden increase or decrease in uric acid levels. The normal level of uric acid in blood should not exceed 7 mg/dl. An attack of gout begins when the urate crystals precipitate within the joints and causes an inflammation. Accumulation of sodium urate crystals is called as tophi, and this happens on repeated attacks. Tophi is deposited in the peripheral areas of the body, such as great toe, the hands and the ear. This may also lead to kidney stones with chronic renal disease.

There are four stages in which gout is identified:

1. Asymptomatic hyperuricemia
2. Acute gouty arthritis
3. Intercritical gout
4. Chronic tophaceous gout

The development of gout is directly related to the duration and magnitude of hyperuricemia. Acute arthritis is the early symptom of gout. Around 75% of all people affected with gout experience them on the big toe, but it can affect any toes or fingers, ankle or knees. An attack is triggered by dieting, intake of alcohol, trauma, illness, drugs, or stress. Early attack subsides within 3 to 10 days without any treatment. But the subsequent attack affects more joints and last longer.There may be a gap of months or years between early and subsequent attack.

The symptoms of gout includes severe pain, redness, swelling, and warmth on the affected joint. The onset is usually abrupt and often occurs in night. Colchicine or any non-steroidal anti inflammatory drug, such as indomethacin, is used to relieve an acute attack of gout. Treatment of hyperuricemia, tophi, joint destruction and renal problems are initiated after the initial inflammatory problem subsides.

Uricosuric agents such as probenecid is used to correct hyperuricemia and also dissolve the deposited urate. Allopurinol is the drug of choice, but its use is restricted because of the risk of toxicity. Uricosuric agents are indicated when there is hyperuricemia, and allopurinol is indicated when there is renal stones or remal insufficiency. Be aware of the medicine's action and side effects, and take them only on your physicians advice.

Gout in short is the excess secretion of uric acid due to which urate crystals build up in joints causing inflamation and pain.

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