Apr 6, 2014
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GOUT

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A term used to describe several disorders associated with a raised concentration of URIC ACID in the blood, of which various forms of inflammatory disease and kidney disease are the most important. The condition has an overall prevalence in the UK of around 0·6 per cent.

Causes 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 and there is a family history of the disease in 50–80 per cent of cases. Inadequate exercise, habitual over-indulgence in animal food and rich dishes, and excess of alcohol have been indicated as precipitating 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 males. In women it most often appears during the menopause.

Symptoms An attack of gout may appear without warning, or there may be premonitory symptoms. The affected joint is swollen and the symptoms come and go, usually being worse at night. Tophi (see TOPHUS) may develop around an affected joint. Urinary CALCULI (uratebased) often occur in patients with gout.

Treatment and prevention NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) such as NAPROXEN should be started as soon as possible for an acute attack. After the attack subsides, a lower dose should be continued for at least a week. Salicylates (such as aspirin) and diuretics should be avoided.

In patients prone to recurrent or particularly severe attacks, long-term prophylaxis with ALLOPURINOL is indicated, especially when associated with 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.

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