Gout
Rakieh, C & Conaghan, P. (2011). Diagnosis and treatment of gout in primary care.
The Practitioner, 255 (1746):17-20
Gout, once called the 'rich man's disease,' is the most common form of inflammatory arthritis in men over the age of 40. Risk increases with age and an estimated 7% of men aged over 65 and 3% of women aged over 85 have gout. It is caused by the deposition of monosodium urate (MSU) crystals in the joints as a consequence of raised serum uric acid levels. But while increased uric acid clearly poses an additional risk, hyperuricaemia is more common than full-fledged gout, indicating other risk factors are significant.
The risk of gout is associated with high levels of alcohol consumption. Consumption of large amounts of red meat (and other purine-rich foods like seafood) is also associated with gout, while dairy products and coffee are protective. Approximately 1-2% of the population has gout, an unsurprising statistic given its association with poor diet and the fact that diets high in alcohol and red meat are more common in the developed world. Metabolic syndrome (obesity with insulin resistance) is also strongly associated with gout. Certain medications such as diuretics can contribute to gout. Gout can only be diagnosed conclusively by analyzing the affected joints for MSU crystals in the synovial fluid. Inflamed and painful joints are one of the primary symptoms of gout. Gout is a chronic disease and sufferers experience occasional flare-ups with remissions. Over time, tophi may form at the affected joints.
Gout is treated with NSAIDs and other anti-inflammatory drugs such as steroids. Uric acid lowering therapy may be required if diet and lifestyle modifications fail to control the disease.
Bullets
Gout is more common in men than women and prevalence increases with age
It is a lifestyle disease and is particularly associated with a lifestyle common in the developed world -- high in red meat and seafood consumption and alcohol
Gout primarily presents itself as inflammation of the joints and bouts are usually followed by periods of remission
Tests for MSU crystals in the synovial fluid in an inflamed joint are required to confirm a diagnosis
Diet and exercise modifications, along with anti-inflammatories are the usual first step in recommended treatment
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