Gout is a common form of arthritis characterized by sudden, severe attacks of pain and inflammation in the joints, often in the big toe. It is caused by high levels of uric acid in the blood that form needle-like crystals in the joints. Risk factors include age, genetics, diet high in purines, obesity, kidney problems, and certain medications. Symptoms include intense joint pain, swelling, redness, and limited range of motion. Diagnosis involves testing joint fluid or blood for uric acid crystals. Treatment focuses on medications to relieve pain and prevent further attacks and complications by reducing uric acid levels.

1. GOUT
Gout is a common and complex form of arthritis that can affect anyone. It's characterized by sudden,
severe attacks of pain, swelling, redness and tenderness in the joints, often the joint at the base of the
big toe.
Causes
 Gout is caused initially by an excess of uric acid in the blood, or hyperuricemia.
 Uric acid is produced in the body during the breakdown of purines – chemical compounds that
are found in high amounts in certain foods such as meat, poultry, and seafood.
 Normally, uric acid is dissolved in the blood and is excreted from the body in urine via the
kidneys.
 If too much uric acid is produced, or not enough is excreted, it can build up and form needle-like
crystals that trigger inflammation and pain in the joints and surrounding tissue.
Pathogenesis
An elevated serum urate level, together with local factors, can result in the deposition of urate
crystals into the joints. Once crystals are deposited into a joint, they can be released into the
joint space and initiate an inflammatory cascade causing acute gouty arthritis.

2. Signs and symptoms
Signs and symptoms of gout almost always occur suddenly, and often at night. They include:
 Intense joint pain. Gout usually affects the large joint of big toe, but it can occur in any joint.
Other commonly affected joints include the ankles, knees, elbows, wrists and fingers. The pain is
likely to be most severe within the first four to 12 hours after it begins.
 Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from
a few days to a few weeks. Later attacks are likely to last longer and affect more joints.
 Inflammation and redness. The affected joint or joints become swollen, tender, warm and red.
 Limited range of motion. As gout progresses, you may not be able to move joints normally.
Risk factors
There are a number of factors that can increase the likelihood of hyperuricemia, and therefore gout:

3. Age and gender: Men produce more uric acid than women, though women’s levels of uric acid approach
those of men after the menopause.
Genetics: A family history of gout increases the likelihood of the condition developing.
Lifestyle choices: Alcohol consumption interferes with the removal of uric acid from the body. Eating a
high-purine diet also increases the amount of uric acid in the body.
Lead exposure: Chronic lead exposure has been linked to some cases of gout.
Medications: Certain medications can increase the levels of uric acid in the body; these include some
diuretics and drugs containing salicylate.
Weight: Being overweight increases the risk of gout as there is more turnover of body tissue, which
means more production of uric acid as a metabolic waste product. Higher levels of body fat also increase
levels of systemic inflammation as fat cells produce pro-inflammatory cytokines.
Recent trauma or surgery: Increases risk.
Other health problems: Renal insufficiency and other kidney problems can reduce the body’s ability to
efficiently remove waste products, leading to elevated uric acid levels. Other conditions associated with
gout include high blood pressure and diabetes.
Complications
In some cases, gout can develop into more serious conditions, such as:
 Kidney stones: If urate crystals collect in the urinary tract, they can become kidney stones.
 Recurrent gout: Some people only ever have one flare up; others may have regular recurrences,
causing gradual damage to the joints and surrounding tissue.
Diagnosis
Tests to help diagnose gout may include:

4. Joint fluid test: Use a needle to draw fluid from affected joint. Urate crystals may be visible when the
fluid is examined under a microscope.
Blood test: Doctor may recommend a blood test to measure the levels of uric acid and creatinine in
blood. Blood test results can be misleading, though. Some people have high uric acid levels, but never
experience gout. And some people have signs and symptoms of gout, but don't have unusual levels of
uric acid in their blood.
X-ray imaging: Joint X-rays can be helpful to rule out other causes of joint inflammation.
Ultrasound. Musculoskeletal ultrasound can detect urate crystals in a joint or in a tophus. This technique
is more widely used in Europe than in the United States.
Dual energy CT scan: This type of imaging can detect the presence of urate crystals in a joint, even when
it is not acutely inflamed. This test is not used routinely in clinical practice due to the expense and is not
widely available.
Treatment
1. Medications to treat gout attacks
 Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include over-the-counter options such
as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), as well as more-powerful
prescription NSAIDs such as indomethacin (Indocin) or celecoxib (Celebrex).
 Colchicine, a type of pain reliever that effectively reduces gout pain.
 Corticosteroids. Corticosteroid medications, such as the drug prednisone, may control gout
inflammation and pain.
2. Medications to prevent gout complications
 Medications that block uric acid production. Drugs called xanthine oxidase inhibitors (XOIs),
including allopurinol (Aloprim, Lopurin, Zyloprim) and febuxostat (Uloric), limit the amount of
uric acid
 Medication that improves uric acid removal. These drugs, called uricosurics, include
probenecid (Probalan) and lesinurad (Zurampic).