There is more to gout than the stereotypical vignette of the portly rich man with his swollen foot on a velvet footstool. Gout is a condition caused by excess uric acid, a normal waste product found in the blood. While genetics play a part in determining who gets gout, it is also strongly associated with obesity, several other health conditions and diet. Elevated uric acid levels can lead to the formation of urate crystals, which collect in and around joints as well as in the urinary tract. Painful episodes of recurrent arthritis and kidney stones can result. If left untreated, additional health problems can emerge.
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The first gout attack, often occurring after years of unrecognized high uric levels in the bloodstream, typically involves intense pain, redness, swelling and warmth in one or two joints. The joint of one big toe is often afflicted. Telltale urate crystals can be found in the joint at this time. This arthritic episode typically resolves after several days to a week. Classically, further episodes will occur that eventually involve other joints. Over time, the deposition of urate crystals and resulting inflammation can deform and destroy joints.
Eventually, urate crystals accumulate in other tissues, creating usually painless lumps called tophi. Tophi can show up on tendons such as the Achilles tendon, soft tissues and the outer rim of the ear. Tophi are not as common now thanks to the availability of treatment, which involves daily medication to control uric acid levels and medication for gout attacks. Restricting purines in the diet, such as those found in meat and some seafood, also helps, as these compounds break down into uric acid. Avoiding alcohol, especially beer, and fructose-containing drinks can also lower gout risk.
High uric acid levels in the blood can lead to the formation of uric acid stones in the kidneys. These stones can eventually result in impaired kidney function, and they can create blockages in the urinary tract, blood in the urine and painful episodes if they are dislodged and move into the relatively narrow ureters leading to the bladder. Complicating the picture, gout often occurs in individuals who are overweight, hypertensive and possibly diabetic. All of these conditions can interact and have a greater negative impact on kidney function.
The frequent co-existence of gout and heart disease has been noted for years. It has been difficult to tease out whether gout elevates a person's risk of heart disease. Recent research, such as that shared in an April 2013 “Current Pharmaceutical Design” article, has started to develop a case for elevated uric acid's independent role in the development of both kidney and heart disease. A September 2010 article in the "Netherlands Journal of Medicine" summed up a possible reason by noting that the inflammation of gout is often associated with an acceleration of atherosclerosis. Gout's role in contributing to heart disease will surely continue to be a topic of exploration.