Gout, a disease long known through history as "The Disease of Kings" or the "Rich Man's disease", is a severely painful condition caused from too much uric acid (monosodium urate) in the body. 

When your body has too much uric acid (a condition known as "hyperuricemia"), some of these needle-shaped crystals tend to deposit outside the bloodstream, often around a joint.  When such deposits develop and cause pain, the condition is termed "gout".  

So hyperuricemia is different from gout?

Yes, they're different, but they are related.  Hyperuricemia is simply the condition of having an abnormally-high amount of uric acid in the blood stream.  Gout is the painful condition that sometimes occurs as a result of hyperuricemia. 

It's important to note that not everyone with hyperuricemia will develop gout. 

What is uric acid, exactly?

Uric acid is a crystalline product your body produces naturally from the use of protein. 

Why does your body sometimes have too much uric Acid?

Hyperuricemia (or too much uric acid in the body) may be caused by your body producing too much uric acid (90% of cases), or by your body's inability to get rid of the uric acid it has (10% of cases).

Anyone can get hyperuricemia, but it's most frequent in overweight men over 40 and post-menopausal women.  Poor diet, alcohol use (especially beer and red wine), certain type of anemia, high blood pressure (hypertension), the use of diuretics, renal (kidney) impairment, trauma, and genetics also play a role. 

If all those factors play a role in getting gout, why was it known as the "Rich Man's Disease" or "The Disease of Kings"?

It used to be that only the wealthier people could afford the rich foods and alcohol associated with the condition.  Actually, today it's just the opposite.  It's more frequently seen in lower economic groups that eat a less healthy diet. 

Where do you get gout?

While gout attacks can occur in various areas around the body, the classic location is the great toe joint (known as podagra.  The first episode of gout hits this joint more than 50% of the time, and in patients with multiple attacks, this joint is affected 90% of the time. 

Why does gout affect the big toe so frequently?

Gout attacks tend to occur in the cooler parts of the body, and in areas where there is relatively more trauma, so the foot is the most common location of gout attacks.  While the classic example of gout is the great toe joint, but it is commonly seen in the heels, ankles, knees, and around joint capsule, tendons and other structures, too.  

Gout can occur in the arms and hands, too, though much less frequently.  In chronic cases, you may also see deposits of uric acid crystals known as tophi, or tophaceous deposits (singular is tophus), in other parts of the body, like the ears and nose, though because there is no joint, these deposits tend not to hurt.  They may be visible underneath the skin, and when removed, look a lot like feta cheese. 

What does a gout attack feel like?

It typically comes on suddenly, often within hours.  The foot becomes red, hot, and swollen.  It can be so painful that even placing a bed sheet on the foot can be excruciating.  Sometimes the patient will also experience fever, chills, and fatigue.

The attack eventually begins to subside, usually within three days, but it may not be completely resolved for weeks. 

The worst thing about gout attacks is that they tend to recur.  The average time between the first attack and a recurrence is about 1 year, unless some preventative treatment occurs. But you never know, a patient may not have another attack for a month, a year--sometimes it never happens again.

Over time, usually years, untreated gout may result in attacks that are more frequent and longer in duration.  Irreversible arthritic damage to joints may also occur.  (For more on gouty arthritis and arthritis in general, visit our arthritis web page.)

And after at years of uncontrolled hyperuricemia, the uric acid deposits known as tophi (discussed above) develop.  

Chronic gout can also cause kidney stones. 

How do you diagnose gout?

Gout is usually diagnosed by patient history, a good physical examination and blood work.  It's important to note that while it may seem counter-intuitive, it's frequently the case where the uric acid in the blood looks lower on blood work tests during an attack of gout.   This is because there are fewer uric acid crystals in the blood at the time because they're crystallizing in the big toe joint or some other area of the body.  

Gout also creates some distinctive changes on X-ray, but these changes don't usually show up right away.  It may take years for X-ray changes to become evidenced.  

How do you treat gout?

Therapy is directed in two ways. 

Management of Acute Gout  

• Rest until the attack subsides

• Colchicine has been use for centuries for this condition, and it is still very effective, often improving symptoms within hours.  Possible side effects make it unsuitable for the elderly, patients with heart, liver or kidney problems.

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), including sulindac, ibuprofen, naproxen, and indomethacin are often helpful during an attack.

• Injections of corticosteroids is a particularly effective treatment, often resolving the attack within 12 to 24 hours.   

Preventing Further Attacks

• Use medications that help you excrete uric acid (a class of drugs known as uricosuric agents)

• Use medications that help you decrease the production of urate (e.g., Allopurinol)

• Lose weight slowly.  (Fast weight loss tends to cause further attacks.)

• Diet Changes.  This means avoiding increasing fluid intake and avoiding:

  • Alcohol (especially red wine and beer)

  • Meats, poultry, fish and seafood.  

  • Fatty foods

  • Certain vegetables--asparagus, cauliflower, beans, peas, mushrooms and spinach 

• Protect the joint from further trauma by wearing loose shoes, and avoiding occupations that are hard on the feet.

• Follow up regularly with your physician. After their first attack, patients should be seen every couple months for a year and then every 6  months.

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