| Gout develops when the level of uric acid in the blood | | | | is extremely painful to the touch and even the touch of |
| is too high. In the past it was known as the patrician's | | | | the bed sheath can induce excruciating pain. The acute |
| malady because it was considered a diseased of over | | | | episode resolves on its own but can take over a |
| indulgence amongst the wealthy. High purine diet can | | | | week. Medication can shorten this time |
| affect gout and red meat is high in purine. The rich ate | | | | Since the introduction in 1951 of probenacid and |
| red meat while the poor could only afford grain. | | | | allopurinol in 1963, chronic gout is rare apart from |
| Gout is predominantly a male disease up to the age of | | | | non-compliant sufferers. Before these drugs were |
| 50. It starts around 30 and the peak is between 40 | | | | introduced chronic gout caused severe distress |
| and 50 years. It is rare in pre-menopausal women. | | | | amongst sufferers. Acute gout was frequent and |
| Hippocrates wrote about gout as a disease of males | | | | severe. In addition urate crystals separated out into |
| and post-menopausal women and urate crystals were | | | | other joints, kidneys and other organs leading to |
| found in the big toe of an Egyptian mummy. | | | | polyarthritis, kidney stones, heart disease and tophi. |
| Gout can be classified as primary and secondary. In | | | | Diet and weight loss has an important role in gout |
| primary gout the body either produces too much uric | | | | management. A low intake of purine can reduce blood |
| acid or it cannot excrete it effectively to maintain a | | | | urate level by up to 20%. Foods high in purine are |
| normal blood level. These patients benefit significantly | | | | meat especially liver and other organ meat, sausages |
| from dietary changes. Secondary gout develops as a | | | | and other processed meat, seafood, milk, eggs and |
| result of other factors. Some medical conditions can | | | | certain beans. Alcohol increases the possibility of gout. |
| raise uric acid level and trigger gout. These include | | | | Beer is the worse culprit. It contains guanosine. This |
| renal disease and myeloproliferative disorders. In | | | | chemical is converted by the gut flora into uric acid. |
| leukaemia, the imbalance is due to excessive | | | | Today, with screening and tests done for insurance |
| production of uric acid, and in renal disease the | | | | purpose, we are seeing a group of individuals with high |
| excretion of uric acid is impeded. Drugs can affect | | | | uric acid without any signs of gout. These people need |
| blood uric acid levels. These include diuretics especially | | | | to be monitored. Once all potential factors that can |
| thiazide diuretics, aspirin and cytotoxic drugs. Gout is | | | | influence gout are eliminated or reduced and diet and |
| also linked to obesity and alcohol. | | | | weight loss in place, if the uric acid level remains high, |
| Acute gout usually develops during the night. 70-90% | | | | then maintenance therapy in the form of allopurinol is |
| of acute gout develops in the big toe and typically | | | | recommended to keep the blood uric acid level within |
| affects the first metatarso-phalangeal joint. This is | | | | the normal range. This stops urate crystals separating |
| called podagra. Within hours the pain becomes severe | | | | out into important parts of the body. |
| and throbbing. The big toe swells up and can feel hot. It | | | | |