A term used to describe several disorders associated with a raised concentration of URIC ACID in the blood, of which various forms of INFLAMMATORY ARTHRITIS and KIDNEY DISEASE are the most important. The condition has an overall prevalence in the UK of around 0.6 per cent.
The cardinal feature of gout is the presence of an excessive amount of uric acid in PLASMA and various body tissues, and its deposition in the joints in the form of sodium monourate. The cause of this excess is not known, but there is an hereditary element with a family history of the disease in 50–80 per cent of cases. Obesity and excess alcohol intake are important risk factors but the disease can occur in vegetarians and teetotallers.
Gout is infrequent before the age of 40, but it may occasionally affect very young people in whom there is a strong family history. About 95 per cent of patients are male. In women it most often appears during the menopause.
An attack of gout may appear without warning, or there may be premonitory symptoms. The affected single joint becomes rapidly swollen and painful. Over the years, acute symptoms come and go or arthritis can become chronic with tophi (see TOPHUS) developing around the affected joints. Urinary CALCULI (urate-based) often occur in patients with gout.
NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) COLCHICINE or CORTICOSTEROIDS are generally prescribed for an acute attack. After the attack subsides, a lower dose may continue for a time.
In patients prone to recurrent or particularly severe attacks, long-term prophylaxis with ALLOPURINOL is often advised, especially when there is associated kidney disease. This drug, which has few side-effects, lowers the serum urate concentration by preventing the formation of uric acid. A sensible weight-reducing diet is usually helpful.