Gout, also called crystal-induced arthritis, is an arthritic condition that occurs when uric acid crystals accumulate in the joints. Gout usually affects the large joint of the big toe, but can also affect other joints, such as the knee, ankle, foot, hand, wrist and elbow. In rare cases, it may later affect the shoulders, hips or spine. Gout does not spread from joint to joint.

What is uric acid then?
Uric acid is a substance that normally forms when the body breaks down waste products (called purines). It is an unstable compund found in blood, tissue, plasma which ionise to form sodium urate. Uric acid is usually dissolved in the blood and passes through the kidneys into the urine. For people with gout, the uric acid level in the blood is so high that uric acid crystals form and deposit in joints and other tissues. This causes the joint lining to become inflamed, resulting in sudden and severe attacks of pain, tenderness, redness and warmth.
After several years, the crystals can build up in the joints and surrounding tissues, forming large deposits, called tophi. Tophi look like lumps under the skin and are often found in or near severely affected joints, on or near the elbow, over the fingers and toes, and in the outer edge of the ear

Causes and Risk Factors of Gout
In about 90 percent of all cases, gout is prevalent in men older than 40 and in menopausal women. An "episode" often occurs overnight, and within 12 to 24 hours, there is severe pain and swelling in the affected joint. The episode usually lasts about five to 10 days.

Although the exact cause is unknown, gout may be caused by:

i) genetic defect in metabolism, which causes overproduction and undersecretion (retention) of uric acid (eg. Glucose-6-phosphatase deficiency, Lesch-Nyhan sundrome)

ii) kidney impairment (eg. chronic renal disease, or even hypertension which can cause kidney disorder) that prevents normal elimination of uric acid

iii) dehydration due to certain conditions such as diabetes insipidus, thiazide diuretic medications (water pills) used to treat high blood pressure and heart failure

iv) diseases of the blood cells and blood-forming organs, certain cancers and psoriasis

v) environmental factors, such as obesity, alcohol abuse and a purine-rich diet.

vi) hormonal disorders ( eg. hyperparathyroidism, hypothyroidism)

An episode of gout can be triggered by:

i) drinking too much alcohol (causes dehydration)
ii) eating too much of the wrong foods ( purine-rich food)
iii) surgery
iv) sudden, severe illness (especially heart and kidney diseases)
v) crash diets
vi) injury to a joint
vii) chemotherapy
vii) dehydration
viii) stress
ix) rigorous exercise (causes lactic acid production, thus decreasing elimination of uric acid)

Symptoms of Gout
Gout generally occurs in four (4) stages (asymptomatic, acute, intercritical and chronic) and has the following signs and symptoms:

Asymptomatic stage - urate levels rise in the blood, but produces no symptoms

Acute stage - symptoms usually lasting five to 10 days
-sudden attack of joint pain
-joints feel hot, tender and look dusty red or bruised

Intercritical stage - symptom-free intervals between gout episodes. Most people have a second attack from six months to two years, while others are symptom-free for five to 10 years.

Chronic stage
-persistently painful joints with large urate deposits in the cartilage, membranes between the bones, tendons and soft tissues
-skin over the deposits develop sores and release a white pus
joint stiffness
-limited motion of affect joint

Diagnosis of Gout
The diagnosis of gout is based on symptoms, blood tests showing high levels of uric acid, and the finding of urate crystals in synovial joint fluid(via fine needle aspiration). In chronic gout, x-rays show damage to the cartilage and bones

Treatment of Gout
Currently, there is no cure for gout, but through proper diet, a healthy lifestyle and medications, the symptoms of gout can be relieved and further episodes eliminated.

Proper diet
Avoid or restrict foods high in purine (a substance that produces uric acid when broken down). These foods include:

sardines, anchovies, brains, liver, kidneys, tripe, sweetbreads, tongue, shellfish (mussels and oysters), fish roe, scallops, peas, lentils, beans, spinack, celery, asparagus, mushroom, plums, prunes, corns and an excessive amount of red meat.

Drink 10 to 12 eight-ounce glasses of non-alcoholic fluids daily.

Healthy lifestyle
Reduce alcohol consumption
Lose weight

Using medications for gout can be complicated, because the treatment needs to be tailored for each person and may need to be changed from time to time.

To relieve the pain and swelling of an acute attack, the doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, corticosteroid drugs, and/or adrenocorticotropic hormone (ACTH).

To prevent future attacks, the doctor may recommend colchicine, probenecid (Benemid, Parbenem or Probalan), sulfinpyrazone (Anturane), or allopurinol (Lopurin, Zurinol or Zyloprim).

To prevent or treat tophi, probenecid, sulfinpyrazone and allopurinol are recommended.

All of these drugs are powerful, so the patient needs to understand why they are taking them, what side effects may occur and what to do if they have problems with the medication.

Allopurinol is an inhibitor of uric acid synthesis. It acts as an analogue of hypoxanthine, the penultimate product of uric acid synthesis, thus inhibiting the enzyme xanthine oxidase which converts hypoxanthine to xanthine and xanthine to uric acid. During binding, allopurinol is converted to alloxanthine (oxypurinol) which binds tightly to the enzyme xanthine oxidase, thus the enzyme is not releases and inactivated permanently. Allopurinol is hence called a suicide inhibitor. Xanthine could no longer be converted to uric acid, and uric acid production decreases. The accumulation of xanthine and hypoxanthine is virtually harmless as it is more soluble and increases the salvage pathway which reutilise them. Therefore, there are less deposits of crystals in the joints.

Reference: http://www.healthscout.com/ency/68/174/main.html

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