Gout

Gout is a disease due to an inborn disorder of the uric acid metabolism. In this condition monosodium urate crystals are deposited on the articular cartilage of joints and in the particular tissue like tendons. This provokes an inflammatory reaction of these tissues. These deposits often increase in size and burst through the skin to form sinuses discharging a chalky white material.

Normally, the human bloodstream only carries small amounts of uric acid. However, if the blood has an elevated concentration of uric acid, uric acid crystals are deposited in the cartilage and tissue surrounding joints. Elevated blood levels of uric acid can also result in uric kidney stones.

The classic picture is of excruciating and sudden pain, swelling, redness, warmness and stiffness in the joint. Low-grade fever may also be present. The patient usually suffers from two sources of pain. The crystals inside the joint cause intense pain whenever the affected area is moved. The inflammation of the tissues around the joint also causes the skin to be swollen, tender and sore if it is even slightly touched. For example, a blanket draping over the affected area could cause extreme pain.

Gout usually attacks the big toe, however it can also affect other joints such as the ankle, heel, instep, knee, wrist, elbow, fingers, and spine. In some cases the condition may appear in the joints of the small toes which have become immobile due to impact injury earlier in life, causing poor blood circulation that leads to gout.

Acutely, first line treatment should be pain relief. Once the diagnosis has been confirmed, the drugs of choice are indomethacin, other nonsteroidal anti-inflammatory drugs, or intra-articular glucocorticoids, administered via a joint injection.

Long term treatment is antihyperuricemic therapy. Because the body metabolizes purines into uric acid, a maintained, low-purine diet can help lower the plasma urate level. Avoiding alcohol, high-purine foods, such as meat, fish, dry beans, mushrooms, spinach, asparagus, and cauliflower can lower plasma urate levels. In addition, consuming purine-neutralizing foods, such as fresh fruits and most fresh vegetables, diluted celery juice, distilled water, and B-complex and C vitamins can also help lower plasma urate levels.

...More at Wikipedia

Related Links:

• US National Library of Medicine
• Mayo Clinic

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