OVERVIEW
Gout is a very painful condition in the joints that occurs in some people who have chronically high levels of uric acid in the blood that causes joint inflammation. It is characterized by sudden, severe attacks of pain, redness, and tenderness at the joints, often at the joint at the base of the big toe. Patients with gout are at an increased risk of developing kidney stones and rarely, damage to the kidney itself.

RISK FACTORS AND CAUSES
The exact cause is unknown, but many risk factors have been identified:

• Male gender
• Menopause in women
• Excessive alcohol drinking (especially beer, whiskey, gin, vodka, and rum)
• Obesity
• High blood pressure
• Injury or recent surgery
• Fasting
• Overeating
• Eating large amounts of meat, seafood, and drinking beverages with large amounts of high-fructose corn syrup
• Medications that affect blood levels of uric acid (ie. diuretics)

SYMPTOMS
The symptoms of gout are sudden, severe joint pain with redness, tenderness, and swelling at the joint. Only one or a few joints are usually involved, most commonly the big toe, ankle, and knee joints. The pain starts suddenly, often during the night and may be accompanied by a fever. The attacks go away after a few days but often recur. These sudden attacks are called “acute gouty arthritis” and the period between attacks is called the “intercritical period.” Patients with repeated attacks of gout can develop something called “tophaceous gout,” which is characterized by large numbers of urate crystals in joints, bursae, bones, cartilage, and under the skin. These tophi may cause bone erosion and joint damage.

DIAGNOSIS
Aside from inquiring about the symptoms mentioned above, your doctor may order several tests. These include:

• Synovial fluid analysis to see evidence of uric acid crystals (synovial fluid is the fluid in joints)
• Blood levels of uric acid
• Joint x-rays
• Synovial biopsy
• Urine levels of uric acid

TREATMENT
Medications should be taken as quickly as possible if you have a sudden attack of gout. These may include:

• Non-steroidal anti-inflammatory drugs or NSAIDs (ibuprofen, naproxen, indomethacin)
• Your doctor might prescribe stronger painkillers, such as codeine, hydrocodone, and oxycodone
• Colchicine. This drug helps reduce pain, swelling, and inflammation
• Corticosteroids

If you have had several attacks in one year, your attacks are severe, you have joint damage, you have tophi, or if you have uric acid kidney stones, your doctor may prescribe allopurinol or probenecid, drugs that help decrease levels of uric acid in the blood.
Furthermore, lifestyle changes can help prevent gouty attacks, such as avoiding alcohol, reducing purine rich foods (anchovies, sardines, oils, herring, liver meat, kidney meat, sweetbreads, legumes, gravies, mushrooms, spinach, asparagus, cauliflower, consommé, and baking yeast), limiting amount of meat eaten, and avoiding fatty foods. If you are trying to lose weight, you should do so slowly because quick weight loss can cause uric acid kidney stones.

PREVENTION
While the disease itself may not be preventable, you can help prevent attacks by implementing the lifestyle changes mentioned above, such as avoiding alcohol, eating a low-purine diet, limiting amount of meat you eat, and avoiding fatty foods.

ADDITIONAL INFORMATION
To read more about gout, please visit:

• UpToDate
  Patient information: Gout (Beyond the Basics)
• Mayo Clinic
  Gout
• PubMed Health
  Gout