Gout is a broad term used for the problems with uric acid metabolism in the body. Gout is also referred to as metabolic arthritis due to similar symptoms. As such, gout causes severe pain in joints and associated tissues from the buildup of monosodium urate crystals that lay stagnate in the articular cartilage of joints. This articular cartilage tissue covers the ends of bones and allows the distribution of weight and compression for normal body movement. It also provides a wear-resistant surface for joint movement and when inflamed is very painful. The inflammatory response from this buildup of urate crystals causes pain to the joints and swelling at the site. If not treated, the swelling can grow and increase in size until it bursts through the skin. Obesity is a major risk factor for developing gout and early diagnosis and treatment are essential to reduce disease morbidity.
Gout is one of the oldest human ailments seen throughout time and obesity has played a major role in how it has been perceived throughout cultures. Some accounts identify gout first with the Egyptians circa 2640 B.C.E. Later, Hippocrates in the 5th century B.C.E., identified gout as separate from other joint disorders and referred to it as the “unwalkable disease.” Nonetheless, healers have consistently associated gout with the consumption of rich foods and excessive alcohol. This led those who suffer from gout to be seen as decadent and corpulent, as the foods that seem to contribute to the disease were only available to the wealthy. This negative stereotype is most evident by seeing that gout was also referred to as the “disease of kings” by some historical accounts. Now, with the disease process better understood, these negative stereotypes are no longer tolerated.
In the United States today, gout is twice as prevalent in African-American males as it is in Caucasians. Internationally, the prevalence of gout varies widely from country to country. For example, in England, gout affects about 16 out of every 1,000 men and three of every 1,000 women. There is an increased prevalence of gout among obese individuals across populations. Gout can also develop as comorbidity of other diseases, including diabetes, hypertension, and obesity.
The clinical presentation is severe and sudden pain, swelling, redness, warmness, and stiffness to the affected joint. The urate crystals inside the joint cause intense pain whenever the affected area is moved and the inflammation of the tissues around the joint also cause skin to be swollen and tender to touch. Hyperuricemia, a high level of uric acid in the blood, is a common sign of gout and is considered an aspect of the metabolic syndrome. However, a high uric acid blood level does not exclusively mean a person will develop gout.
Treatment of proven crystal-induced arthritis is directed at relief of the pain and inflammation. Narcotic pain relievers, nonsteroidal antiinflammatory drugs (NSAIDs), and steroids are standard treatment. Last, for extreme cases of gout, surgery may be necessary to remove large areas of affected tissues and correct joint deformity. The best prevention measure for gout is a low purine diet and a reduction in alcohol consumption.
Alcohol; High Protein Diets
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