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Gout
Other namesPodagra
Video summary (script). Leading with The Gout (James Gillray, 1799) depicts the pain of the artist's gout as a demon or dragon.[1][2]
Pronunciation
SymptomsJoint pain, swelling, and redness[4]
Usual onsetOlder males,[4] post-menopausal women[5]
CausesUric acid[5]
Risk factorsDiet high in meat or beer, being overweight[4][6]
Differential diagnosisJoint infection, rheumatoid arthritis, pseudogout, others[7]
PreventionWeight loss, vitamin C, not drinking alcohol, allopurinol[8]
TreatmentNSAIDs, steroids, colchicine[5][9]
Frequency1–2% (developed world)[8]

Gout is a form of inflammatory arthritis characterized by recurrent attacks of a red, tender, hot, and swollen joint.[4][5] Pain typically comes on rapidly, reaching maximal intensity in less than 12 hours.[8] The joint at the base of the big toe is affected in about half of cases.[10] It may also result in tophi, kidney stones, or kidney damage.[4]

Gout is due to persistently elevated levels of uric acid in the blood.[5][8] This occurs from a combination of diet, other health problems, and genetic factors.[4][5] At high levels, uric acid crystallizes and the crystals deposit in joints, tendons, and surrounding tissues, resulting in an attack of gout.[4] Gout occurs more commonly in those who regularly eat meat or seafood, drink beer, or are overweight.[4][6] Diagnosis of gout may be confirmed by the presence of crystals in the joint fluid or in a deposit outside the joint.[4] Blood uric acid levels may be normal during an attack.[4]

Treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, or colchicine improves symptoms.[4][5][11] 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.[8] Taking vitamin C and eating a diet high in low-fat dairy products may be preventive.[12][13]

Gout affects about 1 to 2% of the Western population at some point in their lives.[8] It has become more common in recent decades.[4] This is believed to be due to increasing risk factors in the population, such as metabolic syndrome, longer life expectancy, and changes in diet.[8] Older males are most commonly affected.[4] Gout was historically known as "the disease of kings" or "rich man's disease".[8][14] It has been recognized at least since the time of the ancient Egyptians.[8]

References

  1. ^ Brookhiser, Richard (2008). Gentleman Revolutionary: Gouverneur Morris, the Rake Who Wrote the Constitution. Simon and Schuster. p. 212. ISBN 9781439104088. Archived from the original on 2016-05-01. Retrieved 2016-01-10.
  2. ^ Haslam, Fiona (1996). From Hogarth to Rowlandson : medicine in art in eighteenth-century Britain (1. publ. ed.). Liverpool: Liverpool University Press. p. 143. ISBN 9780853236405. Archived from the original on 2016-05-13. Retrieved 2016-01-10.
  3. ^ "Gout | Definition of Gout by Lexico". Lexico Dictionaries | English. Archived from the original on 19 October 2019. Retrieved 20 October 2019.
  4. ^ a b c d e f g h i j k l m Cite error: The named reference Dalbeth2016 was invoked but never defined (see the help page).
  5. ^ a b c d e f g Hui, M; Carr, A; Cameron, S; Davenport, G; Doherty, M; Forrester, H; Jenkins, W; Jordan, KM; Mallen, CD; McDonald, TM; Nuki, G; Pywell, A; Zhang, W; Roddy, E; British Society for Rheumatology Standards, Audit and Guidelines Working, Group. (26 May 2017). "The British Society for Rheumatology Guideline for the Management of Gout". Rheumatology (Oxford, England). 56 (7): e1–e20. doi:10.1093/rheumatology/kex156. PMID 28549177.
  6. ^ a b Beyl Jr, R. N.; 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.
  7. ^ Neogi, T (July 2016). "Gout". Annals of Internal Medicine (Review). 165 (1): ITC1-16. doi:10.7326/AITC201607050. PMID 27380294.
  8. ^ a b c d e f g h i Richette P, Bardin T (January 2010). "Gout". Lancet. 375 (9711): 318–28. doi:10.1016/S0140-6736(09)60883-7. PMID 19692116.
  9. ^ Qaseem, A; Harris, RP; Forciea, MA; Clinical Guidelines Committee of the American College of, Physicians. (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.
  10. ^ Schlesinger N (March 2010). "Diagnosing and treating gout: a review to aid primary care physicians". Postgrad Med. 122 (2): 157–61. doi:10.3810/pgm.2010.03.2133. PMID 20203467.
  11. ^ Shekelle, P. G; Newberry, S. J; Fitzgerald, J. D; Motala, A; O'Hanlon, C. E; Tariq, A; Okunogbe, A; Han, D; Shanman, R (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.
  12. ^ "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.
  13. ^ Roddy, E; Choi, HK (May 2014). "Epidemiology of gout". Rheumatic Diseases Clinics of North America. 40 (2): 155–75. doi:10.1016/j.rdc.2014.01.001. PMC 4119792. PMID 24703341.
  14. ^ "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 2013-11-14. Retrieved 2009-05-01.
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