Gout
Description
- Gout, also known as gouty arthritis, results from monosodium urate deposits that
cause red, swollen, and acutely painful joints. Gout may affect any joint but mostly
affects those in the feet, especially the great toe, ankle and midfoot.1
Causes
- Painful gouty arthritis is caused by uric acid crystal deposits in joint tissue.
This happens when uric acid levels in the body are abnormally high.
- The underlying cause of primary gout is not clearly understood but in many patients
the disease results from decreased renal excretion of uric acid. In a few patients
gout is linked to a genetic defect in purine metabolism that causes an overproduction
of uric acid.2
- Gout and hyperuricemia can be promoted by obesity, acute weight gain, alcohol
intake, high blood pressure, abnormal kidney function, and certain drugs.
Types
- Primary gout typically occurs in men over thirty and postmenopausal women who
take diuretics. Secondary gout develops during the course of another illness (i.e.
obesity, diabetes mellitus, hypertension, renal disease and others) or following
treatment with drugs (i.e. hydrochlorothianzide).3
At Risk
- The tendency to develop gout and elevated blood uric acid level (hyperuricemia)
is often inherited.
Prevention and Management
General:
- Gouty arthritis attacks can be precipitated by dehydration, injury, fever, heavy
eating, heavy drinking of alcohol, and recent surgery. Because obesity may be a
factor in secondary gout, weight loss is often suggested.
- Almost all people with gout have too much uric acid in their blood, a condition
called hyperuricemia. However, there are many people who have hyperuricemia but
not gout.
- It is important to drink plenty of fluids.
Nutritional Influences:
- Adjunct therapy attempts to reduce the consumption of alcohol and purine-rich
foods such as anchovies, liver, sardines, kidneys, sweet-breads, lentils and other
beans.
- An experimental study suggested that vitamin C lowers uric acid levels in serum
by increasing renal excretion.4
- Zinc levels may be depressed during disease activity.5
Additional Information
Abstracts
Emmerson BT. The management of gout. N Engl J Med 1996 Feb 15;334(7):445-51. We
now have sufficient knowledge to be able to identify the factors contributing to
hyperuricemia in most patients with gout. Some of these factors, such as obesity,
a high-purine diet, regular alcohol consumption, and diuretic therapy, may be correctable.
In patients with persistent hyperuricemia, regular medication should lower the serum
urate concentration to an optimal level. The continuing challenge is to educate patients
about correctable factors and the importance of regular medication and ensure their
compliance so that attacks of gout do not recur.
1 Diseases. Springhouse (PA):Springhouse Corporation; 1993 p 50.
2 Diseases. 2nd ed. Springhouse (PA):Springhouse Corporation; 1993. p 898.
3 Diseases. 2nd ed. Springhouse (PA):Springhouse Corporation; 1993. p 893.
4 Stein HB et al. Ascorbic acid-induced uricosuria: A consequence of megavitamin
therapy. Ann Intern Med 1976;84(4):385-8.
5 Mataroan Perez L et al. [Zinc in arthrosis and microcrystalline arthritis].
Rev Clin Esp 1991;189(2):60-2.
