Gout!

Gout



“The Gout” James Gillray

Once called the “king of diseases, the disease of kings”, gout has been around since antiquity. Identified in 2640 BC by the Egyptians and later recognized by Hippocrates in fifth century BC, Gout is derived from the Latin word ‘gutta’ meaning ‘drop’.

Historically, gout is associated with an individual’s having the money to enjoy a diet abundant in meats, cheeses and wine hence the nickname of “Rich man’s disease”. A painful condition of the joints, gout is caused by increased levels of uric acid a product of purine [protein] metabolism. Foods rich in purines, such as meats and cheeses, certain wines and fishes, can help to precipitate gouty attacks. Gout is caused either by the body over producing uric acid or not being able to excrete uric acid fast enough to prevent build-up. Most commonly middle-aged men are affected by gout, although often the disease is seen in women. Hence the term ‘under-excreters or over-producers. This is often the way to tailor drug treatment to manage the gouty attacks and prevent a recurrence. Lab work and on occasion, a urine sample will help determine the type of patient and tailor the drug treatment.

The classical presentation of gout is described as a toe that is very red, swollen and warm. The toe is so painful that that even the touch of a light bed sheet is agonizing. Depositing into the joint space, uric acid crystals cause an inflammatory response responsible for the hallmarks of a red, swollen, and painful joint. Usually gouty attack occurs in one joint, most commonly the big toe (‘great toe’ or ‘hallux’). Gout of the big toe joint is known as Podagra. Drinking plenty of fluids, maintaining a healthy BMI (basal metabolic index = weight), and minimizing alcohol consumption can help to minimize gouty flare-ups. Typically, the painful joint resolves in several days with medications, dietary changes and rest. More information on diet can be found here: http://www.mayoclinic.com/health/gout-diet/MY01137