Arthritis Treatment: What Is Gout and How Is It Diagnosed?

Gout is a disease that has its roots in antiquity. While it once was considered a disease of the affluent, it is now a much more democratic condition affecting people of all socioeconomic groups.

It is a painful and debilitating form of arthritis that affects more than three million Americans, with the incidence increasing.

Gout is part of the "metabolic syndrome" which includes other co-morbid conditions such as obesity, high blood pressure, elevated blood lipids, and diabetes.

As mentioned earlier, the incidence of the disease appears to be increasing possibly due to the growing epidemic of obesity as well as other factors described below. Symptoms include excruciatingly painful attacks of arthritis affecting single joints, most often in the feet and most commonly affecting the big toe joint- the first metatarsophalangeal joint.

Gout is due to an excess of uric acid (UA). UA is a waste product- a byproduct of the metabolism of foods that contain high levels of purines. When UA accumulates, it deposits in joints and other organ systems.

The reason UA builds up is because either the production increases or because the body can't get rid of it through the kidneys fast enough.

As blood levels of UA increase, there is deposition of monosodium urate crystals in joints. These needle-shaped crystals attract white blood cells which release enzymes that cause a severe inflammatory reaction leading to the pain, swelling, redness, and heat that are hallmarks of a severe acute gout attack.

It's not just the joints that suffer the ill effects of monosodium urate crystal deposition. When these deposits form in organs like the kidneys, severe damage can ensue with the formation of kidney stones, kidney tissue inflammation, and kidney failure.

Triggers that increase UA levels include purine-rich foods like red meat, shellfish, and alcohol as well as certain medicines like diuretics, immunosuppressive drugs. Also, fructose containing beverages are contributing to the increasing incidence of gout.

The diagnosis of gout is suspected by the pattern of acute painful attacks of swelling, heat, redness, and pain affecting one or two joints, generally in the foot followed by a period of no symptoms until the next attack.

For some odd reason, gout attacks generally begin at night. One theory is that the feet tend to cool down at night, facilitating the deposit of monosodium urate crystals.

The serum UA is usually elevated at the time of an attack but it can be normal in rare cases.