Gout

Description: A metabolic disease characterised by painful inflammation of a joint, especially of the big toe, and an excess of uric acid in the blood.

Persons most commonly affected: Adults of both sexes and all age groups, particularly men aged over 60. Uncommon below 40 years of age unless there is high incidence within a family.

Organ or part of body involved: Joints.

Symptoms and indications: First appears as a sudden and extremely painful attack in a single joint, usually the big toe. Later attacks can involve several joints, such as the ankle, knee, wrist, and elbow. The pain, which commonly begins at night during sleep, may occur without warning or may be preceded by excessive alcohol consumption or unusual exercise earlier in the day. The pain grows in intensity and is often described as throbbing or crushing. Inflammation follows, with swelling, warmth, redness, and tenderness over the infected joints.

Causes and risk factors: The cause is high-circulating blood levels of uric acid (an organic acid containing nitrogen, which is the end product of the metabolism of protein) leading to the formation and deposition of urates in the joints. There is often a genetic, family predisposition towards the development of the condition, and this is usually the case in a young person with gout. Some blood diseases such as leukaemia and the use of certain drugs and antibiotics may increase the likelihood of a person developing gout. Alcohol increases the production of uric acid and must be eliminated from the diet. Alcohol is known to have diuretic effects which can contribute to dehydration and precipitate acute gout attacks. Alcohol can also affect uric acid metabolism and cause hyperuricemia. It causes gout by impeding (slowing down) the excretion of uric acid from the kidneys as well as by causing dehydration, which precipitates the crystals in the joints.

Prevention: Drinking at least 2 litres of water a day helps to flush urate crystals out via the kidneys. Losing weight is important if it is above normal, since uric acid levels. Certain foods that are high in purines can increase uric acid levels and thus bring on an acute attack of gout. These foods include red meats, shellfish, beer, red wine, salt, sardines, mushrooms, asparagus, fish, poultry, eggs, dried beans, peas, lentels, cooked spinach and rhubarb. Some medications, such as diuretics (water pills) that are often used to control high blood pressure or reduce swelling, also may cause an acute attack of gout. Stress, infection, and trauma also are possible causes.