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The Kings' Disease

Oh, My Aching Toe!

Once considered the disease of the rich, gout has found its way into the lives of many millions of men and women worldwide and is now the most common form of inflammatory arthritis present today.

Inflammatory arthritis is a condition in which pain is generated through inflammation of tissue in the joint area and is unlike osteoarthritis, where the pain comes from the erosion of cartilage in a joint.

Most often the joint affected with gout is the big toe although it can occur in the knees, ankles, wrists and hands.  Gout strikes suddenly and without warning, leaving the victim in excruciating pain with a red and swollen joint which feels like it's on fire.

Was It Something I Ate?

It was Hippocrates who gave gout the title "the disease of kings" since it was most frequently found in people who indulged in rich diets.  While diet is a factor in the overall scheme of things, a condition known as hyperuricemia is really the primary risk factor in gout.  Hyperuricemia is a medical term which describes high blood levels of uric acid.  The body breaks down proteins and purines during digestion which are later eliminated through urine. Uric acid is the waste product of this breakdown system and when there are elevated levels of uric acid in the body, gout may result.  Changing the diet to avoid eating certain foods which may lower the blood levels of uric acid can be helpful.  In truth though, the way the kidneys process uric acid in the body may be of greater importance than what is eaten.  It is the blood level of uric acid which is the most accurate way to measure what triggers a gout attack.

Gout is a complex disorder and even though hyperuricemia can lead to attacks of gout, hyperuricemia itself does not cause gout.  The pain a person feels in a gout attack - or flare, as they are sometimes called - is the result of inflammation generated by urate deposited in the connective tissues of a joint.  Urate or crystals are formed from the salt deposits of uric acid.  These sharp crystals lodge in either connective tissue or synovial fluid or both, ultimately causing irritation and inflammation.  The ensuing attack usually begins with a sudden, severe pain accompanied by redness, swelling and heat in the joint - most often the big toe.

Am I Doomed?

Gout does have the potential to progress and can eventually lead to joint damage.  However, with proper care and treatment, symptoms of gout are very manageable.  There are many different types of treatments available including medications to ease pain, and medications which may help to prevent future flares.