Gout is a form of inflammatory arthritis characterized by recurrent attacks of a red, tender and hot, and swollen joint.
Pain typically comes on rapidly in less than twelve hours. The joint at the base of the big toe is affected in about half of cases. It may also result in tophi, kidney stones, or urate nephropathy. Gout is due to elevated levels of uric acid in the blood.
This occurs due to a combination of diet and genetic factors. Gout occurs more commonly in those who eat a lot of meat, drink a lot of beer, or are overweight. Diagnosis of gout may be confirmed by seeing the crystals in joint fluid or tophus.Blood uric acid levels may be normal during an attack.
Gout develops as a result of the build-up of purines in the body, either by decreased excretion (about 80% of cases of primary gout) or by increased production (about 10% of primary gout). When the concentration of urate exceeds its solubility, crystals precipitate, and the crystals are phlogistic.
Moreover the crystals lead to activation of the classical and alternative pathways of complement, the influx of neutrophils into the joint, and the release of numerous inflammatory cytokines. Secondary factors that may contribute to the elevation of serum urate and the development of gout include: chronic kidney disease, which impairs urate excretion; lead poisoning, which similarly reduces urate excretion; use of medications that reduce urate excretion, including diuretics, low-dose aspirin and cyclosporine; Acute gout.
In about 60% of acute gout attacks, a single joint becomes suddenly inflamed, often with excruciating pain, swelling and exquisite tenderness. The attack may be accompanied by chills and a low fever.
If untreated, the attack generally peaks within about 24 hours and may linger for weeks, especially if the patient continues to use the affected joint actively. Treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, or colchicine improves symptoms.
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. Taking vitamin C and eating a diet high in low fat dairy products may be preventive.