Gout

About Gout

Gout is a form of inflammatory arthritis caused by deposition of monosodium urate crystals in joints, affecting tens of millions of people worldwide. It is the most common form of inflammatory arthritis in men. Hyperuricemia elevated blood uric acid is necessary but not sufficient for gout. Uric acid levels rise due to overproduction or underexcretion. Risk factors include male sex, obesity, alcohol particularly beer, high purine diet red meat, shellfish, certain medications diuretics, low dose aspirin, cyclosporine, chronic kidney disease, and genetic variants SLC2A9, ABCG2. Acute gout presents with sudden onset of severe joint pain, classically the big toe metatarsophalangeal joint podagra, with redness, swelling, and exquisite tenderness. Attacks often occur at night and may be triggered by alcohol, rich meals, or illness. Chronic gout can cause tophi urate crystal deposits under the skin and joint damage. Diagnosis is confirmed by finding needle shaped negatively birefringent urate crystals in joint fluid under polarized microscopy. Serum uric acid levels support the diagnosis but can be normal during acute attacks. Acute attacks are treated with NSAIDs such as naproxen, colchicine, or corticosteroids, chosen by a clinician. Long term urate lowering therapy allopurinol, febuxostat prevents attacks and complications, and guidelines define a target serum urate level, with a lower target for people with tophi.