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Gout

Gout is a disorder characterized by sudden, recurring attacks of very painful arthritis caused by deposits of monosodium urate crystals, which accumulate in the joints because of an abnormally high uric acid level in the blood (hyperuricemia)

Cause

Joint inflamation can become chronic and deforming after repeated attacks. Almost 20% of the peoplewho have gout develop kidney stones.

Normally some uric acid, a by-product of cell breakdown, is present in the blood because the body is continually breaking down cells and forming new ones and because familiar foods contain precursors of uric acid. The uric acid level becomes abnormally high when the kidneys can't eliminate enough in the urine. The body may also produce very large amounts of uric acid because of a hereditary enzyme abnormality or a disease such as blood cancer, in which cells multiply and are rapidly destroyed. Some types of kidney disease and certain drugs impair the kidneys' ability to eliminate uric acid.

Symptoms

Attacks of gout (acute gouty arthritis) occur without warning. They may be triggered by a minor injury, surgery, consumption of large quantities of alcohol or protein-rich food, fatigue, emotional stress, or illness. Typically, severe pain occurs suddenly in one or more joints, often at night; the pain becomes progressively worse and often is excrutiating. The joint swells, and the skin over the joint appears red or purplish, tight, and shiny, and it feels warm. Touching the skin over the joint can be extremely painful.

The disorder most often affects the joint at the base of the big toe, causing a condition called podagra, but it also commonly affects the instep, ankle, knee, wrist, and elbow. Crystals may form in these peripherally located joints because they are cooler than the central part of the body and urate tends to crystallize at cooler temperatures. Crystals also form in the ears and other relatively cool tissues. In contrast, gout rarely affects the spine, hips, or shoulders.

Other symptoms of acute gouty arthritis can include fever, chills, a general sick feeling, and a rapid heartbeat. Gout tends to be more severe in people who develop symptoms before age 30. Usually, gout develops during middle age in men and after menopause in women.

The first few attacks usually affect only one joint and last for a few days. The symptoms gradually disappears, the joint's function returns, and no symptoms appear until the next attack. However, if the disorder progresses, untreated attacks last longer, occur more frequently, and affect several joints. Affected joints may be permanently damaged.

Severe, chronic gout that causes a deformity may develop. Urate crystals continually deposited in the joints and tendons cause damage that increasingly restricts joint motion. Hard lumps of urate crystals (tophi) are deposited under the skin on the ears, or around the elbow. If untreated, tophi on the hands and feet can erupt and discharge chalky masses of crystals.

Diagnosis

Treatment