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Gout 

 

Definition

Gout causes inflammation and pain in the joints, much the same as arthritis does. It occurs when uric acid, usually carried in small amounts in the bloodstream, reaches such a high level that it crystallizes in the joints. 

There are several reasons for elevated uric acid levels, including:

  • a hereditary enzyme deficiency

  • a blood cancer

  • kidney disease

  • disruption of the bodyís ability to eliminate it (by certain prescription drugs, for example)

A gout attack can happen very suddenly, producing severe joint pain and swelling and a purplish discoloration of the skin over the affected area. The person often feels ill and feverish. In someone who is prone to gout, causes of an attack include:

  • an injury

  • another illness

  • stress or fatigue

  • surgery for an unrelated problem

  • overindulgence in alcohol or rich food

At first, only one joint is usually affected. Most often, itís the one at the base of the big toe. Other areas affected by gout can include the feet, ankle, knee, elbow and wrist. 

Treatment

Left alone, a first attack of gout will resolve on its own within a few days. But going without treatment can cause the attacks to become more frequent and extensive, and last longer. Over time, permanent joint damage will occur. Therefore, it is important to see a physician as soon as possible during or after a first episode. 

Gout, like arthritis, is usually treated with short courses of nonsteroidal anti-inflammatory drugs. Some patients also need to take corticosteroids (in pills or by injection) to help relieve the inflammation. If the patient has severe discomfort, a physician may prescribe an additional pain reliever. An older drug, colchicine, is used less often now than used to be the case but is sometimes added to the regimen to make sure the gout doesnít flare up again. 

Once the attack has ended, prevention is very important. People with gout often learn to recognize the early signs of an attack and can take their prescription medication to ward it off. 

Some people develop chronic gout and must continue to take preventive medication. This can include the drugs mentioned above and agents designed to lower uric acid in the blood (such as probenecid) or inhibit its production in the body (such as allopurinol).

 

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