Gout Disease

There are around 200 kinds of arthritis and Gout is a type of inflammatory arthritis. It is also called podagra as it affects the big toe.
It is caused due to accumulation of uric acid crystals in tissues affecting the joints and musculoskeletal system.

Gout is extremely painful and it affects mainly men (16 men in every 1000), but less common in women (3 women in every 1000) who rarely suffer from it before menopause.
It happens because of the body’s inability to metabolise uric acid.
Larger amount of Uric acid is produced as a byproduct in the body during the breakdown of certain proteins called purines present in our body cells.
Some amount of uric acid comes from the breakdown of purines present in some foods and drinks such as shellfish, red meat, and certain alcohols, such as beer.

Generally, in soluble form, it is excreted from the body through the kidneys.
In hyperuricemic condition, excess uric acid accumulates in the tissues and forms needle-like crystals.
It causes inflammation and pain in the joints and surrounding tissue. Gout may occur alone (primary gout) or may be associated with other medical conditions (secondary gout).

Ancient Egyptians first identified this condition in 2,640 BC and they called it as "the disease of kings" or "rich man's disease".

Symptoms:

The big toe is a common place for the gout to start and the painful aching of it can be felt in knees, wrists, ankles, heels, fingers and in almost any part of the body, but never in spine.
The Gout attacks of big toe occur suddenly in the middle of the night.
Gout usually affects the large joint of big toe with intense joint pain, but it can also occur in feet, ankles, knees, elbows, wrists, and fingers.
The pain is likely to be most severe within the first four to 12 hours after it begins. The affected joints become swollen, tender, warm and red.

If gout is not treated and remains long standing, uric acid crystals may be deposited in kidneys causing kidney stones.
It may also cause irreversible joint damage. Uric acid kidney stones from gout may cause abdominal pain.
Uric acid can deposit in the soft tissues, especially around joints, and cause nodules known as tophi, which can be large and unsightly.

By a process called crystal shedding, some of the crystals accumulated in the joints, spill out into the joint cavity i.e. the space between the bones. These hard, needle shaped crystals touch the soft lining of the joint causing inflammation.

Gout is not contagious.

Causes and Risk factors

Attacks of gouty arthritis occur when there is a sudden change in uric acid levels in the blood. It may be caused by

• Overweight,
• Intake of alcoholic beverages, especially beer, intake of diets rich in red meats, internal organs, yeast, shellfish, and oily fish that are high in chemicals called purines,
• People with insufficient kidney function, some medicines such as water pills (diuretics), and some other anti-hypertensive medications,  aspirin (Bayer, Ecotrin), nicotinic acid (B-3-50, B3-500-Gr, Niacin SR, Niacor, Niaspan ER, Slo-Niacin), cyclosporin A, allopurinol (Zyloprim), probenecid (Benemid), can cause gout.  
• Starvation and dehydration,
• chemotherapy are also risk factors for gout attack.

Uric acid levels increase at puberty in men and at menopause in women.
So, Post-pubertal males are at increased risk for gout compared with women.
Gout is rare in premenopausal women.
If parents are suffering from gout, the genes may be inherited and there are 20% chances of developing gout in the children.
The chances of developing gout is five times more in British people than others and among blacks, American blacks are more likely to develop gout than other populations.

To manage gout, plenty of water and other fluids should be taken, body weight should be controlled by taking moderate amounts of a healthy mix of foods with all required nutrients and daily intake of meat, seafood, and alcohol (especially beer) should be limited.
To get relief from the pain, anti-inflammatory medicine are to be taken. But Aspirin never should be taken as it raises the uric acid level in the blood and will make gout worse.

Doctor’s prescription should be followed to reduce the accumulation of uric acid in blood and to prevent future gout attacks.