Doctors have recognized gout since Hippocrates in ancient Greece. In the sixth century B.C., a physician from Byzantium, Alexander of Tralles, found that a laxative was effective in treating gout. That same treatment is still effective for gout today.
Over the centuries, the belief was that only the rich got gout, those that could afford fine wines and roast beef and chicken dinners. The cartoon of the obese rich man with his foot elevated and his big toe red and swollen isn't far off. Inflammation of the big toe joint is present in over 50% of acute cases. The joint becomes red, hot, swollen, and exquisitely painful overnight. Usually the disease starts with just one joint, but it can progress to multiple joints.
Gout is caused by the disposition of uric acid crystals in the soft tissues of joints. Uric acid is a waste product from the breakdown of a chemical called purine, which is found in high concentrations in some foods. Several mechanisms can raise uric acid levels including:
There are two separate treatments. The first is for an acute attack. The second is preventive treatment after the initial episode has subsided. Treatment of acute gout includes:
Many patients never have a second attack. If repeat flares occur, the person is started on medications to lower the levels.
Once the initial episode has resolved, maintenance therapy may be started if indicated. If started too soon, drug therapy can make the attack not only worse but also longer. The purpose of drug therapy is to decrease uric acid levels and keep them low, preventing further flares.
Gout is an extremely painful disease that is preventable. You should evaluate your diet and alcohol intake, maintain a healthy weight, and see your doctor for routine exams. Ask about gout, especially if you have a family history.
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