Part of the Diseases Quest.

Gout is a kidney condition in which, for causes unknown, the kidneys fail to eliminate enough uric acid from the blood, or the body produces too much, causing concentrations rise to a point where the vile stuff crystalizes into sharp, needle-like bits, which are then carried by circulation and gravity into the joints, usually of the lower extremities (i.e. toes, ankles, knees).

I have gout. Most frequently my attacks occur in the big joint where the big toe joins the foot, but I have been hospitalized twice for attacks in the knees. The best one was when my right knee and left ankle were both inflamed, and I couldn't even use crutches to get around. Good thing I have a penis and had plenty of empty Gatorade bottles around! I've heard of rare occasions where other joints are affected, the two I've heard of are the elbow, and, (god forbid), the back. I have *absolutely* no desire to find out what a gout attack in the spine would feel like.

Treatments for gout are broken into two types, preventative and curative. Preventative treatments include drug therapies, either using Allopurinol or Probenecid, depending on the results of certain tests your physician will preform. You get one if the cause of your gout is excess production of uric acid, and the other if your problem is insufficient elimination of the normal ammounts of uric acid your body produces.

Other preventatives are mostly diet related. Certain foods and drinks are known to exacerbate or promulgate gouty symptoms. Alcohol, particularly red wine, is bad, in some chemical ways, and some diuretic ways. Organ meats, shrimp and shellfish, red meat in general, and for some odd reason, peas, all contribute to flareups, and are best avoided. As it is a diuretic, caffeine is also something to stay away from.

Hydration may be the best preventative of all, for if your body has enough water, the uric acid never comes out of solution to form crystals in the first place, and the more you urinate, the more of it leaves your body. Other good ideas are cranberry juice and black cherry juice. There are also some herbal remedies, etc, but I've never had any luck with these.

Treatments are much more limited, but thankfully, also very effective.

Colchicine is the primary drug given to fight the symptoms, usually in conjunction with painkillers and anti inflammatories (NSAIDs), the best of which is called Toredol. Great stuff, if anyone out there knows how I can get hold of a bottle of the injectable form of this, drop me a line. DO NOT TAKE ASPIRIN if you're having an attack. It does nothing but make it worse, I guess through adding more acids to your system.

One of the odd collateral symptoms of gout is swelling, the joints filling with additional fluid to cushion themselves against the ravages of the tiny crystalline needles. Joints full of water are stiffer, and hurt more, and the fluid may also contribute to a future case of arthritis, so, if you get gout in a major joint (like the knee), you can look forward to having it drained.

The first time I had my knee drained was the single most painful experience I've ever had, followed by a near-orgasmic flow of relief. I've had my joints drained so many times now that I don't even bother to go to the doctor's office anymore, I just do them myself.

cardinal's writeup above is a good personal viewpoint but I thought I might add some medical info.

A form of crystal arthritis associated with hyperuricaemia. Hyperuricemia is defined as a plasma urate level greater than 420 mol/L (7.0 mg/dL); hyperuricaemia is a cardinal feature of gout and necessary for gout. A high uric acid level does not necessarily mean that you will get gout - but the higher your uric acid level, the higher your risk of getting gout.

People with gout have either an increased production of uric acid or an impaired excretion of uric acid or a combination of the two. Not necessarily a problem with the kidneys, though this would be a common cause of gout.
also see uric acid metabolism

High uric acid levels are associated with age, obesity, type IV hyperlipidaemia, diabetes mellitus, ischaemic heart disease and hypertension.

The classical picture is of excruciating pain of sudden onset in only one joint, usually the big toe (75% of first attacks are the fist metatarsal-phalangeal joint).

A definitive diagnosis of gout is from microscopy of joint fluid aspirated from the joint (this test may be difficult to perform) to demonstrate intracellular monosodium urate crystals in synovial fluid polymorphonuclear leukocytes.

Serum urate levels are usually raised. Serum urea and creatinine may be raised if there is any renal impairment.


Treatment

Acutely, first line treatment should be pain relief. Once the diagnosis has been confirmed, the drugs of choice are colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs), or intraarticular glucocorticoids.

Long term treatment is antihyperuricaemic therapy. Dietary change can make a small contribution to lowering the plasma urate level if a diet low in purines is considered. The mainstay of this approach, however, is the drug allopurinol, a xanthine oxidase inhibitor, which directly reduces the production and increases urinary excretion of uric acid.

The decision to use allopurinol is often a lifelong one. Patients have been known to relapse into acute arthritic gout when they stop taking their allopurinol, as the changing of their serum urate levels seems to cause crystal precipitation.


source:
Kumar and Clark Clinical Medicine, 4th Edition 1998.
Harrison's online, June 2000.

Gout (gout), n. [F. goutte a drop, the gout, the disease being considered as a defluxion, fr. L. gutta drop.]

1.

A drop; a clot or coagulation.

On thy blade and dudgeon gouts of blood.
Shak.

2. (Med.)

A constitutional disease, occurring by paroxysms. It consists in an inflammation of the fibrous and ligamentous parts of the joints, and almost always attacks first the great toe, next the smaller joints, after which it may attack the greater articulations. It is attended with various sympathetic phenomena, particularly in the digestive organs. It may also attack internal organs, as the stomach, the intestines, etc. Dunglison.

3.

A disease of cornstalks. See Corn fly, under Corn.

Gout stones. See Chalkstone, n., 2.

 

© Webster 1913


Gout (gOO), n. [F., fr. L. gustus taste. See Gusto.]

Taste; relish.

 

© Webster 1913

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