Gout
Gout, complex disease of uncertain origin caused by the faulty metabolism of uric acid produced in the body by breakdown of protein, and resulting in elevated levels of uric acid in the blood. A diet rich in malt liquors, wines, and certain types of protein may precipitate individual attacks but does not cause the disease. Its incidence is not usually affected by climate or season; about 95 percent of sufferers are men. The disease is rare in people under the age of 30; from 10 to 20 percent of cases have a familial history.
Acute attacks are characterized by severe pain in the joints, often in the big toe, but sometimes in the ankle, knee, hip, shoulder, wrist, or elbow. The attack usually begins abruptly; the joint becomes swollen, red, inflamed, and extremely tender. Untreated attacks last from a few days to a week or more.
Repeated attacks may result in the development of a condition known as chronic tophaceous gout. In this condition crystals of uric acid lodge as white, chalky material in soft body tissues and in and about the joints, where they may cause bursitis and destruction of bone. Large and deforming deposits may, after many years, settle in the outer margins of the ears, a characteristic feature of the disease. Chronic gout may also cause kidney damage by the formation of uric acid stones, a condition called urate, or gouty, nephropathy.
The treatment of both types of gout calls for complete rest of the limb and a simple diet, low in poultry, legumes, liver and other organ meats and high water intake to reduce the uric acid content of the body. Sodium salicylate and corticosteroids may be prescribed, or a corticosteriod may be injected into the affected joint. The acute phase is managed with anti-inflammatory drugs, such as colchicine or indomethacin. Chronic gout is usually treated by agents that promote excretion of uric acid, such as probenecid, and agents that inhibit production of uric acid, such as allopurinol.
Acute attacks are characterized by severe pain in the joints, often in the big toe, but sometimes in the ankle, knee, hip, shoulder, wrist, or elbow. The attack usually begins abruptly; the joint becomes swollen, red, inflamed, and extremely tender. Untreated attacks last from a few days to a week or more.
Repeated attacks may result in the development of a condition known as chronic tophaceous gout. In this condition crystals of uric acid lodge as white, chalky material in soft body tissues and in and about the joints, where they may cause bursitis and destruction of bone. Large and deforming deposits may, after many years, settle in the outer margins of the ears, a characteristic feature of the disease. Chronic gout may also cause kidney damage by the formation of uric acid stones, a condition called urate, or gouty, nephropathy.
The treatment of both types of gout calls for complete rest of the limb and a simple diet, low in poultry, legumes, liver and other organ meats and high water intake to reduce the uric acid content of the body. Sodium salicylate and corticosteroids may be prescribed, or a corticosteriod may be injected into the affected joint. The acute phase is managed with anti-inflammatory drugs, such as colchicine or indomethacin. Chronic gout is usually treated by agents that promote excretion of uric acid, such as probenecid, and agents that inhibit production of uric acid, such as allopurinol.
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