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Gout

"Podagra" redirects here. For the moth genus, see Podagra (moth).

Gout
Other namesArthritis uratica, or Podagra when of the foot
Video summary (script). Leading with The Gout (James Gillray, 1799), which depicts the pain of the artist's gout as a demon or dragon.[1][2]
SpecialtyRheumatology
SymptomsJoint pain, swelling, and redness[3]
Usual onsetOlder males,[3] post-menopausal women[4]
CausesUric acid[4]
Risk factorsDiet high in meat or beer, being overweight, genetics[3][5]
Differential diagnosisJoint infection, rheumatoid arthritis, pseudogout, others[6]
PreventionWeight loss, abstinence from drinking alcohol, allopurinol[7]
TreatmentNSAIDs, glucocorticoids, colchicine[4][8]
Frequency1–2% (developed world)[7]

Gout (/ɡaʊt/ GOWT[9]) is a form of inflammatory arthritis characterized by recurrent attacks of pain in a red, tender, hot, and swollen joint,[4][10] caused by the deposition of needle-like crystals of uric acid known as monosodium urate crystals.[11] Pain typically comes on rapidly, reaching maximal intensity in less than 12 hours.[7] The joint at the base of the big toe is affected (Podagra) in about half of cases.[12][13] It may also result in tophi, kidney stones, or kidney damage.[3]

Gout is due to persistently elevated levels of uric acid (urate) in the blood (hyperuricemia).[4][7] This occurs from a combination of diet, other health problems, and genetic factors.[3][4] At high levels, uric acid crystallizes and the crystals deposit in joints, tendons, and surrounding tissues, resulting in an attack of gout.[3] 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.[3][5] Diagnosis of gout may be confirmed by the presence of crystals in the joint fluid or in a deposit outside the joint.[3] Blood uric acid levels may be normal during an attack.[3]

Treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, or colchicine improves symptoms.[3][4][14] 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.[7] Taking vitamin C and having a diet high in low-fat dairy products may be preventive.[15][16]

Gout affects about 1–2% of adults in the developed world at some point in their lives.[7] It has become more common in recent decades.[3] This is believed to be due to increasing risk factors in the population, such as metabolic syndrome, longer life expectancy, and changes in diet.[7] Older males are most commonly affected.[3] Gout was historically known as "the disease of kings" or "rich man's disease".[7][17] It has been recognized at least since the time of the ancient Egyptians.[7]

  1. ^ Brookhiser R (2008). Gentleman Revolutionary: Gouverneur Morris, the Rake Who Wrote the Constitution. Simon and Schuster. p. 212. ISBN 978-1-4391-0408-8.
  2. ^ Haslam F (1996). From Hogarth to Rowlandson: medicine in art in eighteenth-century Britain (1. publ. ed.). Liverpool: Liverpool University Press. p. 143. ISBN 978-0-85323-640-5.
  3. ^ 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).
  4. ^ 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.
  5. ^ 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.
  6. ^ Neogi T (July 2016). "Gout". Annals of Internal Medicine (Review). 165 (1): ITC1-16. doi:10.7326/AITC201607050. PMID 27380294.
  7. ^ 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.
  8. ^ 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.
  9. ^ "Gout | Definition of Gout by Lexico". Lexico Dictionaries | English. Archived from the original on 19 October 2019. Retrieved 20 October 2019.
  10. ^ 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.
  11. ^ 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.
  12. ^ 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.
  13. ^ "Definition of Podagra". www.merriam-webster.com. Retrieved 19 January 2023.
  14. ^ 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.
  15. ^ "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.
  16. ^ 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.
  17. ^ "Rich Man's Disease – definition of Rich Man's Disease in the Medical dictionary". Free Online Medical Dictionary, Thesaurus and Encyclopedia.

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