Gout is a medical condition characterized by recurrent attacks of acute inflammatory arthritis, usually in the joints of the big toe. It is caused by high levels of uric acid in the blood which form needle-like crystals that accumulate in the joints, tendons and surrounding tissue, causing pain, inflammation and swelling. Symptoms include severe joint pain, redness and swelling of the affected area. Treatment focuses on reducing uric acid levels through lifestyle changes like diet modification and medications.

1. GOUT

2.  The word "gout" is derived from the latin word gutta, meaning "a
drop" (of liquid).
 Gout was historically known as "the disease of kings" or "rich man's
disease".
 Several hundred years ago gout was thought to be caused by drops
of viscous humors that seeped from blood into the joints. In fact, this
supposition was not that far from the truth.
 Gout is a medical condition usually characterized by recurrent
attacks of acute inflammatory arthritis-- a red, tender, hot,swollen
joint.
 The most commonly affected (approximately 50% of cases) part is
the metatarsal-phalangeal joint at the base of the toe.
 However, it may also present as tophi, kidney stones, or urate
nephropathy.
 Gout is also known as podagra when it involves the big toe.
 Gout is more prevalent among men.

3.  High levels of uric acid in the blood is
the main cause of gout.
 When the human body breaks down
chemicals called purines it produces uric
acid.
 Purines can be found naturally in our
body, as well as in food, such as organ
meats, anchovies, asparagus,
mushrooms and herring.
 Most of the time uric acid dissolves and
goes into the urine via the kidneys.
However, if the body is producing too
much uric acid, or if the kidneys are not
excreting enough uric acid, it builds up.
 The accumulation results in sharp urate
crystals which look like needles. They
accumulate in the joints or surrounding
tissue and cause pain, inflammation and
swelling.

4. The uric acid crystallizes, and the
crystals deposit in joints, tendons,
and surrounding tissue.
The following have been known
to bring about a gout attack and
may be contributory causes of
gout:
o obesity
oHeavy alcohol consumption,
especially beer
oDiet high in purin food
oRegular aspirin use
oregular use of diuretic medicines
oTumors
olead poisoning
osurgery

5.  Signs and symptoms of gout are generally acute - they come on
suddenly without warning. A significant proportion of patients experience
them at night.
 Severe pain in the joints - The patient may experience pain in his
ankles, hands, wrists, knees or feet. More commonly the big toe is
affected (podagra). Many patients describe the affected areas as
warm/hot.
 Gradually goes away - A bout can last for over a week if left untreated -
and then gradually goes away during the following week or two
 Itchy and peeling skin later - As the gout subsides the skin around the
affected area may be itchy and peel.
 Redness and inflammation - The sufferer will most likely have tender,
red and swollen joint(s) in the areas that experienced the most pain.
 Fever - Some patients have an elevated temperature.
 Less flexibility - The affected joint may be harder to use, the patient has
limited movement.
 Joint pain usually begins over 2–4 hours and during the night. The
reason for onset at night is due to the lower body temperature then.

6. Gout may be diagnosed and treated
without further investigations in someone
with hyperuricemia and the classic
podagra.
Synovial fluid analysis should be done,
however, if the diagnosis is in doubt.
Blood test - to measure our levels of uric
acid. This test is not definitive as some
people with high uric acid levels never
have gout symptoms; while others who
have gout symptoms do not have high
levels of uric acid in their blood.
Joint fluid test - a needle is used to
collect fluid from the affected joint. The
liquid is then examined under a
microscope to see whether urate crystals
are present.
 x-rays are also done useful for
identifying chronic gout.
Gout on x-
ray of left
foot
Spiked rod of
uric acid
photographe
d under
microscope

7. The initial aim of treatment is to settle the
symptoms of an acute attack.
Repeated attacks can be prevented by
different drugs used to reduce the serum
uric acid levels. Ice applied for 20 to 30
minutes several times a day decreases pain.
 however, 60% of people have a second
attack within one year. Those with gout are
at increased risk of hypertension, diabetes
mellitus, metabolic syndrome, and renal and
cardiovascular disease, thus are at
increased risk of death.
for acute treatment include nonsteroidal
anti-inflammatory drugs (NSAIDs),
colchicine and steroids.
Without treatment, an acute attack of gout
usually resolves in five to seven days.

8.  Both lifestyle changes and medications can
decrease uric acid levels.
 Reduce intake of food such as meat and seafood,
consuming adequate vitamin C limiting alcohol
and fructose consumption, and avoiding obesity.
 A low-calorie diet in obese men decreased uric
acid levels by 100 µmol/l (1.7 mg/dl).
 Vitamin C intake of 1,500 mg per day decreases
the risk of gout by 45%.
 Coffee, but not tea, consumption is associated with
a lower risk of gout.

9.  Gout has become more common in recent decades,
affecting about 1–2% of the western population at some
point in their lives. The increase is believed due to
increasing risk factors in the population, such as metabolic
syndrome, longer life expectancy and changes in diet.
 If we have a sudden and intense pain in a joint get in
touch with our doctor. If we do not treat it, the gout can
gradually get worse over time. If we also have a
temperature, and the joint is hot and/or inflamed, get
medical attention as soon as possible as it may be an
infection.
 More important is to prevent the diease as we know
prevention is better then cure