Gout: - Diagnosing


For centuries, gout was called the "disease of kings" because it seemed to attack the rich and well-fed who drank plenty of alcohol. You don't have to be a king to get gout, but the rest is true: If you are a heavy, middle-aged man who drinks large amounts of alcohol and has a diet rich in proteins, you are at risk of developing gout.
Gout is a painful arthritis caused by hyperuricemia -- high blood levels of a chemical called uric acid. people with gout often can't excrete enough uric acid, make too much of it, or both. Uric acid is a substance your body forms as a breakdown product of purines, which come from foods such as meats, some fish, and alcohol (purines are also made in your body).

What happens in your joints

Normally, uric acid circulates in the bloodstream and is eliminated through the kidneys in the urine. In people with gout, uric acid builds up in the blood and forms sharp crystals that collect in the joints and soft tissues, causing inflammation and sometimes agonizing pain.
Gout attacks without any warning, often in bed at night. A first attack of gout usually begins in the coolest joint -- most commonly the big toe. Other targets include the ankles, heels, knees, and wrists, and eventually almost any joint if the condition goes untreated. The first attack is intense; the pain can be so severe that it can be excruciating to put even a bedsheet over the area. The affected joint swells and the skin becomes taut, shiny, reddish-purple, and hot. Touching or moving the joint is an agonizing experience.
Usually, the first few attacks last only a few days. But if the disorder progresses, untreated episodes last longer, happen more often, and affect more joints, eventually causing permanent damage. High levels of uric acid can also cause kidney stones. Left untreated, gout may lead to the following complications:

  • Deformed joints and reduced mobility
  • Kidney stones
  • Inflammation of the bones, tendons, and ligaments

Although women do get gout, it is much more common in men. (Women do catch up with men after menopause.) Gout can, very rarely, show up in young children, usually due to an inherited abnormality in purine metabolism.

Symptoms you may notice

Acute joint pain at one site, often the big toe, is the most common sign. Other symptoms include:

  • Swelling, redness, warmth, and extreme tenderness of the joint
  • Fever, chills, fatigue, and loss of appetite

If untreated, more symptoms appear:

  • Recurrent attacks, which last longer and become more frequent
  • Uric acid deposits in soft tissues, including the ear, elbows, knees, and fingers
  • Kidney stones or kidney pain (on either side below the ribs)

How gout is diagnosed

Your doctor will examine you and ask about your medical history and any family history of gout. Laboratory tests for gout include checking for uric acid in the blood and urine, and analysis of joints and soft tissue for uric acid deposits. These include:

  • Blood sample to check for elevated uric acid level -- more than 7.5 mg/dl (milligrams per deciliter)
  • Urine analysis to check the level of uric acid by the kidney
  • Samples of tissue or of joint fluid to check for uric acid crystals
  • A complete blood count

In the later stages of gout, X-rays or other imaging tests document the amount of joint damage.
Risk factors

  • Being a middle-aged man or a postmenopausal woman
  • Being overweight
  • Consuming large amounts of alcohol and foods with purines, such as red meats
  • Heredity: if someone in your family has gout, you're more at risk
  • Undergoing chemotherapy or radiotherapy, which rapidly destroys cells and releases additional uric acid into the blood

Also, some drugs may promote the development of gout by raising blood uric acid levels, including the following:

  • Acetazolamide (Diamox)
  • Antineoplastic drugs (used in chemotherapy)
  • Aspirin (aggravates hyperuricemia)
  • Ethacrynic acid (Edecrin)
  • Diuretics (potassium-sparing diuretics, thiazide diuretics)
  • Ethambutol (Myambutol)
  • pyrazinamide
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