What is Gout?
Gout is a form of inflammatory arthritis caused by excess uric acid in the bloodstream, called hyperuricemia. Everyone has uric acid in their body, but in some people the concentration rises excessively causing tiny microscopic crystals of monosodium urate to be deposited in joints and elsewhere. These crystals create an acute inflammation which can be very painful. It most commonly affects the joint at the base of the big toe, called the first metatarsophalangeal joint, but it can happen in any joint in the body. If gout becomes chronic with repeated attacks it can even cause deposits of crystals to form in joints, soft tissues, and around tendons. These lumps of gouty material are called tophi and are often seen on the feet, toes, fingers and back of the elbows. It can also cause permanent damage to joints with repeated attacks. Gout is most common in middle aged to older men and usually only affects women after menopause. It is believed that gout affects about 9 million Americans.
What Causes Gout?
There are many factors that can contribute to gout which include:
- People with certain medical conditions such as high blood pressure, high cholesterol, kidney disease, obesity, and diabetes are more susceptible.
- There seems to be a hereditary component to gout. If other family members have a history of gout you are more likely to get it.
- Eating certain foods which are high in purines that get converted to uric acid can trigger gout. These can include red meats, organ meats like liver, and shellfish such as shrimp, lobster, and crab.
- Food and drinks that are high in fructose.
- Alcohol use, especially beer and wine.
- Joint injury or trauma can trigger an attack.
- Surgery may trigger gout.
- Certain medicines like hydrochlorothiazide (HCTZ), aspirin, cyclosporin, and chemotherapy.
Symptoms of Gout
- Sudden onset of severe pain in a joint accompanied by swelling, increased temperature of the overlying skin, and usually some degree of redness.
- By far the most common joint affected is at the base of the great toe, but it can occur in other joints as well and occasionally in soft tissues like the Achilles tendon.
- Attacks often begin at night while sleeping. The pressure from sheets on the foot may be intolerable. Wearing shoes can also become difficult due to the swelling present.
- If gout has been longstanding, then visible lumps of gout deposits (tophi) may be present on toes, fingers, feet, around the Achilles tendons, the elbows, and other locations. These are usually not painful.