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.


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.

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