Definition

Gout happens when uric acid crystals build up in the joints. This causes the joints to be inflamed. If the crystals build up in the kidneys, kidney stones may result.

Causes

Gout typically occurs if you have high levels of uric acid in your blood (called hyperuricemia). But, you could also have normal uric levels and still have gout.

The liver metabolizes uric acid, and the kidneys get rid of it through the urine. Levels of uric acid build up when:

• Too much uric acid is produced
• Not enough uric acid is eliminated

If you have gout and hyperuricemia, your body doesn't eliminate enough uric acid.

Risk Factors

These factors increase your chance of developing gout. All causes of hyperuricemia are risk factors for gout.

Risk factors include:

• Obesity , sudden weight gain, or rapid weight loss
• Age: over 40 years old
• Sex: male
• Family members with gout
• Diuretics, such as hydrochlorothiazide
• Certain medications, such as aspirin
• High-purine diet (uric acid occurs when purines are broken down), for example:
  • Liver and other organ meats
  • Dried beans and peas
  • Anchovies
  • Gravies
• Alcohol use , especially binge drinking
• Certain types of cancer or cancer treatments (eg, cytotoxic drugs)
• Medications (eg, antiseizure, anti-rejection medications)
• Dehydration
• Hypercholesterolemia
• Kidney disease

Symptoms

Symptoms include:

Acute Gouty Arthritis

• Sudden onset of severe pain in an inflamed joint, usually starting in the big toe
• Joints that are red, hot, swollen, and very tender
• Increased pain 24-36 hours after the onset of symptoms

Gout of the Big Toe

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Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. A sample of fluid from the affected joint will be taken. This fluid will be tested for uric acid crystals.

Other tests may include:

• Blood and urine tests—to measure the level of uric acid in your blood and to assess kidney function
• X-ray —a test that uses radiation to take a picture of structures inside the body, especially bones; used to check for joint destruction

Treatment

Treatment depends on whether the gout is acute or recurrent.

If you are diagnosed with gout, follow your doctor's instructions .

Prevention

To reduce your chance of getting gout:

• Eat a low-purine diet.
• Limit how much alcohol you drink. Avoid binge drinking.
• Drink a lot of fluids.
• Lose weight gradually.
• Talk to your doctor about your risk for high blood pressure and heart attacks . These conditions are associated with gout.