Gout

Gout
Other namesArthritis uratica, or Podagra when of the foot
Medical illustration of the big toe joint affected by gout
SpecialtyRheumatology
SymptomsJoint pain, swelling, and redness[1]
Usual onsetOlder males,[1] postmenopausal women[2]
CausesUric acid[2]
Risk factorsDiet high in meat or beer, being overweight, genetics[1][3]
Differential diagnosisJoint infection, rheumatoid arthritis, pseudogout, others[4]
PreventionWeight loss, abstinence from drinking alcohol, allopurinol[5]
TreatmentNSAIDs, glucocorticoids, colchicine[2][6]
Frequency1–2% (developed world)[5]

Gout (/ɡaʊt/ GOWT[7]) is a form of inflammatory arthritis characterized by recurrent attacks of pain in a red, tender, hot, and swollen joint,[2][8] caused by the deposition of needle-shaped crystals of the monosodium salt of uric acid.[9] Pain typically comes on rapidly, reaching maximal intensity in less than 12 hours.[5] The joint at the base of the big toe is affected (Podagra) in about half of cases.[10][11] It may also result in tophi, kidney stones, or kidney damage.[1]

Gout is due to persistently elevated levels of uric acid (urate) in the blood (hyperuricemia).[2][5] This occurs from a combination of diet, other health problems, and genetic factors.[1][2] At high levels, uric acid crystallizes and the crystals deposit in joints, tendons, and surrounding tissues, resulting in an attack of gout.[1] Gout occurs more commonly in those who regularly drink beer or sugar-sweetened beverages; eat foods that are high in purines such as liver, shellfish, or anchovies; or are overweight.[1][3] Diagnosis of gout may be confirmed by the presence of crystals in the joint fluid or in a deposit outside the joint.[1] Blood uric acid levels may be normal during an attack.[1]

Treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, or colchicine improves symptoms.[1][2][12] Once the acute attack subsides, levels of uric acid can be lowered via lifestyle changes and in those with frequent attacks, allopurinol or probenecid provides long-term prevention.[5] Taking vitamin C and having a diet high in low-fat dairy products may be preventive.[13][14]

Gout affects about 1–2% of adults in the developed world at some point in their lives.[5] It has become more common in recent decades.[1] This is believed to be due to increasing risk factors in the population, such as metabolic syndrome, longer life expectancy, and changes in diet.[5] Older males are most commonly affected.[1] Gout was historically known as "the disease of kings" or "rich man's disease".[5][15] It has been recognized at least since the time of the ancient Egyptians.[5]

  1. ^ a b c d e f g h i j k l Cite error: The named reference Dalbeth2016 was invoked but never defined (see the help page).
  2. ^ a b c d e f g Hui M, Carr A, Cameron S, et al. (26 May 2017). "The British Society for Rheumatology Guideline for the Management of Gout". Rheumatology. 56 (7): e1 – e20. doi:10.1093/rheumatology/kex156. PMID 28549177.
  3. ^ a b Beyl RN Jr, Hughes L, Morgan S (2016). "Update on Importance of Diet in Gout". The American Journal of Medicine. 129 (11): 1153–1158. doi:10.1016/j.amjmed.2016.06.040. PMID 27452679.
  4. ^ Neogi T (July 2016). "Gout". Annals of Internal Medicine (Review). 165 (1): ITC1-16. doi:10.7326/AITC201607050. PMID 27380294.
  5. ^ a b c d e f g h i Richette P, Bardin T (January 2010). "Gout". Lancet. 375 (9711): 318–328. doi:10.1016/S0140-6736(09)60883-7. PMID 19692116. S2CID 208793280.
  6. ^ Qaseem A, Harris RP, Forciea MA, et al. (3 January 2017). "Management of Acute and Recurrent Gout: A Clinical Practice Guideline From the American College of Physicians". Annals of Internal Medicine. 166 (1): 58–68. doi:10.7326/m16-0570. PMID 27802508.
  7. ^ "Gout | Definition of Gout by Lexico". Lexico Dictionaries | English. Archived from the original on 19 October 2019. Retrieved 20 October 2019.
  8. ^ Dalbeth N, Merriman TR, Stamp LK (April 2016). "Gout". Lancet (Review). 388 (10055): 2039–2052. doi:10.1016/S0140-6736(16)00346-9. PMID 27112094. S2CID 208790780.
  9. ^ Abhishek A, Roddy E, Doherty M (February 2017). "Gout - a guide for the general and acute physicians". Clinical Medicine. 17 (1): 54–59. doi:10.7861/clinmedicine.17-1-54. PMC 6297580. PMID 28148582.
  10. ^ Schlesinger N (March 2010). "Diagnosing and treating gout: a review to aid primary care physicians". Postgrad Med. 122 (2): 157–161. doi:10.3810/pgm.2010.03.2133. PMID 20203467. S2CID 35321485.
  11. ^ "Definition of Podagra". www.merriam-webster.com. Archived from the original on 19 January 2023. Retrieved 19 January 2023.
  12. ^ Shekelle PG, Newberry SJ, Fitzgerald JD, et al. (2017). "Management of Gout: A Systematic Review in Support of an American College of Physicians Clinical Practice Guideline". Annals of Internal Medicine. 166 (1): 37–51. doi:10.7326/M16-0461. PMID 27802478.
  13. ^ "Questions and Answers about Gout". National Institute of Arthritis and Musculoskeletal and Skin Diseases. June 2015. Archived from the original on 15 January 2016. Retrieved 2 February 2016.
  14. ^ Roddy E, Choi HK (May 2014). "Epidemiology of gout". Rheumatic Disease Clinics of North America. 40 (2): 155–175. doi:10.1016/j.rdc.2014.01.001. PMC 4119792. PMID 24703341.
  15. ^ "Rich Man's Disease – definition of Rich Man's Disease in the Medical dictionary". Free Online Medical Dictionary, Thesaurus and Encyclopedia. Archived from the original on 14 November 2013. Retrieved 1 May 2009.
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