Gout has been with us since antiquity. In the 4th Century BC, Hippocrates observed that gout was rarely seen in women before the menopause. The word gout comes from the Latin “gutta,” a medieval reference to a drop of evil humour in a painful, reddened great toe. Cartoons of the 17th century often depicted the gout sufferer as a prosperous, portly, wine swelling nobleman. Today, among the more than 100 varieties of arthritis, gout is perhaps the most treatable (and “curable”) of all.
Gout is caused by an excess of uric acid, a normal body waste product. Diuretic drugs (“water pills,” especially thiazides), aspirin, and alcohol may contribute to the problem. Foods containing high fructose corn syrup, often used to sweeten and thicken fruit juices and other soft drinks, may interfere with the elimination of uric acid, triggering attacks. Gout may be genetically linked with obesity, diabetes and heart disease.
Overproduction of uric acid, or difficulty eliminating it, may cause accumulation of this material in joints. The presence of uric acid crystals provokes intense inflammation during a gout attack. The resulting pain is one of the most acute in human experience. The patient may awaken in the middle of the night, unable to tolerate even the weight of the bed sheet on the affected joint. A couple of aspirin, or shot of gin to ease the pain – and the attack gets worse!
Gout is diagnosed when uric acid is detected within the joint. Needle aspiration and microscopic examination of joint fluid is a traditional method of diagnosis. However, in many cases, diagnostic ultrasound may provide a painless method of confirming gout. Although a high blood uric acid level indicates increased risk of gout, this test alone is not a reliable means of confirming the diagnosis.
Treatment requires potent anti-inflammatory medications, followed by measures to control the uric acid level. This often includes a combination of medication and lifestyle changes. The medicines have to be used carefully, and in the proper sequence, to control the attack and prevent further flare-ups. Successful care requires a true partnership between doctor and patient.
Unrecognized, gouty arthritis can cause joint destruction comparable to having severe rheumatoid arthritis. Fortunately, early diagnosis and treatment can make this form of suffering a thing of the past.
Here are some suggested references for more information on this topic:
UpToDate.com for Patients Gout Beyond the Basics
Alan R. Schenk, M.D., FACP