Gout is a common type and the most painful form of arthritis. It has the unique distinction of being one of the most frequently recorded medical conditions throughout history. It is sometimes considered a "rich man’s disease" because it is often associated with the intake of too much rich food and alcohol.
Uric acid
Gout occurs when there are abnormally elevated levels of uric acid in the blood and tissues. Uric acid is the end product of the metabolism of chemicals called purines that are found in many foods. Purines are also found naturally in the body. Some people develop gout because their kidneys have difficulty eliminating normal amounts of uric acid, while others produce too much uric acid. This accumulation of uric acid may also cause kidney stones.
Gout attack
When uric acid accumulates in the blood and tissues it can crystalize out into a joint, forming a multitude of tiny, jagged, needle-shaped crystals. This triggers an intense inflammatory response that causes a painful arthritis attack called a gout attack.
This type of attack commonly strikes the big toe, but other joints can be affected, including the instep, ankle, knee, hips, wrist, elbow and fingers. Acute pain is generally the first symptom and then the affected joint becomes inflamed (almost infected-looking): red, swollen, hot and extremely sensitive to the touch.
Who is at risk of developing gout?
Gout is roughly 9 times more common in men than women. It is strongly associated with being overweight and having high blood pressure. Gout is seen more often in developed countries (perhaps due to the influence of diet, high cholesterol and diabetes). It commonly occurs in middle-age for men and after menopause in women.
While gout is more common in men aged 40 to 60 years, it can also occur in younger men and women.
Risk factors of developing gout
Uric acid is a by-product of the breakdown of certain foods in the body, and gout was once considered to be closely related to diet. It is now understood that inheriting it is the most common reason for gout to occur.
Other factors that put a person at risk for developing gout include: high blood pressure, diabetes, obesity, surgery, chemotherapy, stress, and certain medications and vitamins. For example, the body’s ability to remove uric acid can be negatively affected by taking aspirin, some diuretic medications (“water pills”), and the vitamin niacin (also called nicotinic acid).
Consuming foods and beverages that contain high levels of purines can trigger an attack of gout. Some foods contain more purines than others and have been associated with an increase of uric acid, which leads to gout. You may be able to reduce your chances of getting a gout attack by limiting or avoiding shellfish, organ meats (kidney, liver, etc.), red wine, beer, and red meat.
Also, certain diseases can lead to an excessive production of uric acid in the body, including some leukaemias, lymphomas and some haemoglobin disorders.
Some studies have indicated an increased prevalence of abnormally low thyroid hormone levels (called hypothyroidism) in people with gout.
Aggravating factors
There are a number of conditions that can cause acute attacks of gout. These include:
- dehydration;
- injury to a joint;
- excessive intake of purine-containing foods;
- sudden starvation;
- heavy alcohol intake; and
- recent surgery (this may be related to changes in the body fluid balance because of fasting before surgery).
