Gout
Form of arthritis causing swollen joints / From Wikipedia, the free encyclopedia
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Gout (/ɡaʊt/ GOWT[9]) is a form of inflammatory arthritis characterized by recurrent attacks of a red, tender, hot, and swollen joint,[4][10] caused by the deposition of needle-like crystals of uric acid known as monosodium urate crystals.[11] Pain typically comes on rapidly, reaching maximal intensity in less than 12 hours.[7] The joint at the base of the big toe is affected (Podagra) in about half of cases.[12][13] It may also result in tophi, kidney stones, or kidney damage.[3]
Gout | |
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Other names | Arthritis uratica, or Podagra when of the foot |
Video summary (script). Leading with The Gout (James Gillray, 1799), which depicts the pain of the artist's gout as a demon or dragon.[1][2] | |
Specialty | Rheumatology |
Symptoms | Joint pain, swelling, and redness[3] |
Usual onset | Older males,[3] post-menopausal women[4] |
Causes | Uric acid[4] |
Risk factors | Diet high in meat or beer, being overweight, genetics[3][5] |
Differential diagnosis | Joint infection, rheumatoid arthritis, pseudogout, others[6] |
Prevention | Weight loss, abstinence from drinking alcohol, allopurinol[7] |
Treatment | NSAIDs, glucocorticoids, colchicine[4][8] |
Frequency | 1–2% (developed world)[7] |
Gout is due to persistently elevated levels of uric acid (urate) in the blood (hyperuricemia).[4][7] This occurs from a combination of diet, other health problems, and genetic factors.[3][4] At high levels, uric acid crystallizes and the crystals deposit in joints, tendons, and surrounding tissues, resulting in an attack of gout.[3] Gout occurs more commonly in those who regularly drink beer or sugar-sweetened beverages; eat foods that are high in purines such as liver, shellfish, or anchovies; or are overweight.[3][5] Diagnosis of gout may be confirmed by the presence of crystals in the joint fluid or in a deposit outside the joint.[3] Blood uric acid levels may be normal during an attack.[3]
Treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, or colchicine improves symptoms.[3][4][14] Once the acute attack subsides, levels of uric acid can be lowered via lifestyle changes and in those with frequent attacks, allopurinol or probenecid provides long-term prevention.[7] Taking vitamin C and having a diet high in low-fat dairy products may be preventive.[15][16]
Gout affects about 1–2% of adults in the developed world at some point in their lives.[7] It has become more common in recent decades.[3] This is believed to be due to increasing risk factors in the population, such as metabolic syndrome, longer life expectancy, and changes in diet.[7] Older males are most commonly affected.[3] Gout was historically known as "the disease of kings" or "rich man's disease".[7][17] It has been recognized at least since the time of the ancient Egyptians.[7]