forms of protein (nucleic acids) called purines.
Purines occur naturally in the body as well as in
meats consumed in the diet (especially organ
meats such as liver and fish such as mackerel and
herring). The most common site for gout is the
first (largest) joint of the big toe. Gout may also
affect the metatarsal and tarsal joints in the feet as
well as the ankles and knee; it less commonly
involves the fingers and wrists.
Symptoms and Diagnostic Path
Gout generally begins with sudden and severe PAIN
in the affected joint, usually the first joint of the
big toe. The pain commonly arrives at night and
wakes the person. The affected joint may be red,
swollen, and warm to the touch. The pain and
other symptoms typically go away within 10 days,
and there can be an extended period before symp-
toms return. The diagnostic path includes X-rays
of the affected joints and tests of the BLOODand
URINEto measure uric acid levels. Sometimes the
doctor will numb the joint and use a needle and
syringe to withdraw synovial fluid to examine for
the presence of uric acid crystals. As gout pro-
gresses, often the uric acid crystals also form
deposits, called tophi, under the SKIN.
Treatment Options and OutlookTreatment during a gout attack focuses on reliev-
ing inflammation and pain. NONSTEROIDAL ANTI-
INFLAMMATORY DRUGS (NASAIDS) or CORTICOSTEROID
MEDICATIONSare generally the first line of medica-
tions to target these symptoms. Medications to
reduce the risk for future gout attacks include
colchicine, allopurinol, and probenecid, which
slow the body’s production of uric acid. These
medications do not prevent gout from progressing
but can extend the time between attacks as well as
reduce the permanent damage the inflammation
can cause.FOODS WITH HIGH PURINE CONTENT
anchovies asparagus bacon
beef beer brains
cod crab duck
ham herring kidneys
lentils liver lobster
mackerel mushrooms mussels
oysters sardines scallops
shrimp sweetbreads trout
turkey veal venisonRisk Factors and Preventive Measures
About 20 percent of people who have gout also
have other family members who have gout, giving
rise to suspicion of a genetic factor. Circumstances
that increase the amount of uric acid in the blood
circulation significantly raise the risk for gout.
Such circumstances include consumption of foods
high in purines, medications that affect the body’s
ability to excrete purines (such as diuretic medica-
tions and immunosuppressive drugs afterORGAN
TRANSPLANTATION), DIABETES, HYPERLIPIDEMIA, and
OBESITY. Excessive ALCOHOLconsumption interferes
with the ability of the KIDNEYS to filter uric acid
from the blood. Though there do not appear to be
effective ways to prevent gout from developing,
avoiding circumstances that increase blood uric
acid levels can reduce the frequency and severity
of gout attacks. Men are more likely to develop
gout before age 50 and women after age 50.
See also OSTEOARTHRITIS; RHEUMATOID ARTHRITIS.324 The Musculoskeletal System