Gout Classification and external resources
Uric acid
ICD-10	M10.
ICD-9	274.0 274.1 274.8 274.9
OMIM	138900 300323
DiseasesDB	29031
eMedicine	med/924  orthoped/124 emerg/221 med/1112 oph/506 radio/313
MeSH	D006073

Gout (also called metabolic arthritis) is a disease created by a build up of uric acid. In this condition, monosodium urate or uric acid crystals are deposited on the articular cartilage of joints, tendons and surrounding tissues due to elevated concentrations of uric acid in the blood stream. This provokes an inflammatory reaction of these tissues. Image File history File links File links The following pages link to this file: Uric acid ... Uric acid (or urate) is an organic compound of carbon, nitrogen, oxygen and hydrogen with the formula C5H4N4O3. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // M00-M99 - Diseases of the musculoskeletal system and connective tissue (M00-M25) Arthropathies (M00-M03) Infectious arthropathies (M00) Pyogenic arthritis (M01) Direct infections of joint in infectious and parasitic diseases classified elsewhere (M02) Reactive arthropathies (M023) Reiters disease (M03) Postinfective and reactive arthropathies in diseases classified elsewhere (M05-M14... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Mendelian Inheritance in Man project is a database that catalogues all the known diseases with a genetic component, and - when possible - links them to the relevant genes in the human genome. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... Uric acid (or urate) is an organic compound of carbon, nitrogen, oxygen and hydrogen with the formula C5H4N4O3. ... For other uses, see Crystal (disambiguation). ... Cartilage is a type of dense connective tissue. ...

Signs and symptoms

The Gout, Cartoon by James Gillray (1799). The artist memorably illustrates the excruciating pain and swelling that are symptoms of the disease.

Gout is characterized by excruciating, sudden, unexpected, burning pain, as well as swelling, redness, warmness, and stiffness in the affected joint. Low-grade fever may also be present. The patient usually suffers from two sources of pain. The crystals inside the joint cause intense pain whenever the affected area is moved. The inflammation of the tissues around the joint also causes the skin to be swollen, tender and sore if it is even slightly touched. For example, a blanket or even the lightest sheet draping over the affected area could cause extreme pain Image File history File links The Gout by James Gillray. ... Image File history File links The Gout by James Gillray. ... James Gillray James Gillray, sometimes spelled Gilray (born August 13, 1757 in Chelsea; died June 1, 1815), was a British caricaturist and printmaker famous for his etched political and social satires, mainly published between 1792 and 1810. ...

Gout usually attacks the big toe (approximately 75 percent of first attacks); however, it also can affect other joints such as the ankle, heel, instep, knee, wrist, elbow, fingers, and spine. In some cases, the condition may appear in the joints of small toes that have become immobile due to impact injury earlier in life, causing poor blood circulation that leads to gout. Toes on foot. ...

Patients with longstanding hyperuricemia (see below) can have uric acid crystal deposits called tophi (singular: tophus) in other tissues such as the helix of the ear. Elevated levels of uric acid in the urine can lead to uric acid crystals precipitating in the kidneys or bladder, forming uric acid kidney stones. Hyperuricemia is the presence of high levels of uric acid in the blood. ... A tophus (Latin: stone, plural tophi) is a deposit of crystallised monosodium urate in people with longstanding hyperuricemia. ... A tophus (Latin: stone, plural tophi) is a deposit of crystallised monosodium urate in people with longstanding hyperuricemia. ... A left human ear. ... The kidneys are the organs that filter wastes (such as urea) from the blood and excrete them, along with water, as urine. ... A bladder is a pouch or other flexible enclosure with waterproof or gasproof walls. ... “Bladder stone” redirects here. ...

Diagnosis

A definitive diagnosis of gout is from light microscopy of fluid aspirated from the joints (this test may be difficult to perform) to demonstrate intracellular monosodium urate crystals in synovial fluid polymorphonuclear leukocytes. The urate crystal is identified by strong negative birefringence under polarised microscopy and its needle-like morphology. A trained observer does better in distinguishing them from other crystals. In general, diagnosis (plural diagnoses) has two distinct dictionary definitions. ... Microscopy is any technique for producing visible images of structures or details too small to otherwise be seen by the human eye. ... In cell biology, molecular biology and related fields, the word intracellular means inside the cell. It is used in contrast to extracellular (outside the cell). ... Synovial fluid is a thin, stringy fluid found in the cavities of synovial joints. ... Granulocytes are a category of white blood cells, characterised by the fact that all types have differently staining granules in their cytoplasm on light microscopy. ... A calcite crystal laid upon a paper with some letters showing the double refraction Birefringence, or double refraction, is the decomposition of a ray of light into two rays (the ordinary ray and the extraordinary ray) when it passes through certain types of material, such as calcite crystals or boron...

Hyperuricemia is a common feature, although urate levels are not always raised.^[1] Hyperuricemia is defined as a plasma urate (uric acid) level greater than 420 μmol/L (7.0 mg/dL) in males (or 380 μmol/L in females). However, a high uric acid level does not necessarily mean a person will develop gout. Urate is within the normal range in up to two-thirds of cases.^[2] If gout is suspected, the serum urate test should be repeated once the attack has subsided. Other blood tests commonly performed are full blood count, electrolytes, renal function, thyroid function tests and erythrocyte sedimentation rate (ESR). This helps to exclude other causes of arthritis, most notably septic arthritis, and to investigate any underlying cause for the hyperuricaemia. Hyperuricemia is the presence of high levels of uric acid in the blood. ... Blood plasma is the liquid component of blood, in which the blood cells are suspended. ... Uric acid (or urate) is an organic compound of carbon, nitrogen, oxygen and hydrogen with the formula C5H4N4O3. ... A full blood count (FBC) or complete blood count (CBC) is a test requested by a doctor or other medical professional that gives information about the cells in a patients blood. ... An electrolyte is any substance containing free ions that behaves as an electrically conductive medium. ... In medicine (nephrology) renal function is an indication of the state of the kidney and its role in physiology. ... Thyroid function tests (TFTs) is a collective term for blood tests used to check the function of the thyroid. ... The erythrocyte sedimentation rate (ESR), also called a sedimentation rate, sed rate or Biernacki Reaction, is a non-specific measure of inflammation that is commonly used as a medical screening test. ... Arthritis (from Greek arthro-, joint + -itis, inflammation; plural: arthritides) is a group of conditions where there is damage caused to the joints of the body. ... Septic arthritis is the invasion of a joint by an infectious agent which produces arthritis. ...

Pathogenesis

Gout occurs when mono-sodium urate crystals form on the articular cartilage of joints, on tendons, and in the surrounding tissues. Purine metabolism gives rise to uric acid, which is normally excreted in the urine. Uric acid is more likely to form into crystals when there is a hyperuricemia, although it is 10 times more common without clinical gout than with it.^[3] Many organisms have metabolic pathways to synthesise and break down purines. ... Hyperuricemia is the presence of high levels of uric acid in the blood. ...

Purines can be generated by the body via breakdown of cells in normal cellular turnover, or can be ingested in purine-rich foods such as seafood. The kidneys are responsible for approximately two-third of uric acid excretion, with the gut responsible for the rest. It may be possible that defects in the kidney that may be genetically determined are responsible for the predisposition of individuals for developing gout. Purine is a heterocyclic aromatic organic compound, consisting of a pyrimidine ring that is fused with an imidazole ring. ...

There are also different racial propensities to develop gout. Gout is high among the peoples of the Pacific Islands, and the Māori of New Zealand, but rare in the Australian aborigine despite the latter's higher mean concentration of serum uric acid.^[4] In the United States, gout is twice as prevalent in African American males as it is in Caucasians.^[5] This article is about the Māori people of New Zealand. ...

A seasonal link also may exist, with significantly higher incidence of acute gout attacks occurring in the spring.^[6][7]

Hyperuricemia is considered an aspect of metabolic syndrome, although its prominence has been reduced in recent classifications. This explains the increased prevalence of gout among obese individuals. Metabolic syndrome is a combination of medical disorders that increase ones risk for cardiovascular disease and diabetes. ... Obesity is a condition in which the natural energy reserve, stored in the fatty tissue of humans and other mammals, is increased to a point where it is associated with certain health conditions or increased mortality. ...

Gout is a form of arthritis that affects mostly men between the ages of 40 and 50. The high levels of uric acid in the blood are caused by protein rich foods. Alcohol intake often causes acute attacks of gout and hereditary factors may contribute to the elevation of uric acid. Typically, persons with gout are obese, predisposed to diabetes and hypertension, and at higher risk of heart disease. Gout is more common in affluent societies due to a diet rich in proteins, fat, and alcohol. When it follows as a consequence of other health conditions such as renal failure, it is often regardless of the person's lifestyle.^[8] Lin, et al have statistical evidence linking gout to lead poisoning^[9] and lead level in the body is significantly correlated with urate excretion and gout.^[10] It is known that lead sugar was used to sweeten wine, and that chronic lead poisoning is a cause of gout,^[11][12] which condition is then known as saturnine gout, because of its association with alcohol and excess.^[13] Renal failure or kidney failure is a situation in which the kidneys fail to function adequately. ... Lead(II) acetate or Sugar of Lead was used as an artificial sweetener for wine in ancient times before lead was known to be toxic. ... Lead poisoning is a medical condition, also known as saturnism, plumbism, or painters colic caused by increased blood lead levels. ...

Gout also can develop as co-morbidity of other diseases, including polycythaemia, leukaemia, intake of cytotoxics, obesity, diabetes, hypertension, renal disorders, and hemolytic anemia. This form of gout is often called secondary gout. Diuretics (particularly thiazide diuretics) have traditionally been blamed for precipitating attacks of gout, but a Dutch case-control study from 2006 appears to cast doubt on this conclusion.^[14] Polycythemia is a condition in which there is a net increase in the total circulating erythrocyte (red blood cell) mass of the body. ... Leukemia (leukaemia in Commonwealth English) is a group of blood diseases characterized by malignancies (cancer) of the blood-forming tissues. ... Cytotoxicity is the quality of being poisonous to cells. ... This article is about the disease that features high blood sugar. ... For other forms of hypertension, see Hypertension (disambiguation). ... Kidneys viewed from behind with spine removed The kidneys are bean-shaped excretory organs in vertebrates. ... Hemolytic anemia is anemia due to hemolysis, the abnormal breakdown of red blood cells either in the blood vessels (intravascular hemolysis) or elsewhere in the body (extravascular). ... This illustration shows where some types of diuretics act, and what they do. ... Thiazides are a class of drug that promote water loss from the body ((diuretics)). They inhibit Na+/Cl- reabsorption from the distal convoluted tubules in the kidneys. ...

Gout with tophi on elbow and knee.

Image File history File linksMetadata Download high-resolution version (1932x2576, 2579 KB) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Gout Metadata This file contains additional information, probably added from the digital camera or scanner used to create... Image File history File linksMetadata Download high-resolution version (1932x2576, 2579 KB) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Gout Metadata This file contains additional information, probably added from the digital camera or scanner used to create...

Treatment

Acute attacks

The first line of treatment should be pain relief. Once the diagnosis has been confirmed, the drugs of choice are indomethacin, other nonsteroidal anti-inflammatory drugs (NSAIDs), oral glucocorticoids, or intra-articular glucocorticoids administered via a joint injection. Indomethacin (USAN) or indometacin (INN) is a non-steroidal anti-inflammatory drug commonly used to reduce fever, pain, stiffness, and swelling. ... Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAIDs, are drugs with analgesic, antipyretic and anti-inflammatory effects - they reduce pain, fever and inflammation. ... The name glucocorticoid derives from early observations that these hormones were involved in glucose metabolism. ... The name glucocorticoid derives from early observations that these hormones were involved in glucose metabolism. ... In medicine, a joint injection is a procedure used in the treatment of inflammatory joint conditions, such as rheumatoid arthritis, psoriatic arthritis, gout, tendonitis, bursitis and occasionally osteoarthritis. ...

Colchicine was previously the drug of choice in acute attacks of gout, as it impairs the motility of granulocytes and can prevent the inflammatory phenomena that initiate an attack. Colchicine should be taken within the first 12 hours of the attack and usually relieves the pain within 48 hours, although side effects (gastrointestinal upset such as diarrhea and nausea) can complicate its use. NSAIDs are the preferred form of analgesia for patients with gout. Colchicine is a highly deadly poisonous alkaloid, originally extracted from plants of the genus Colchicum (Autumn crocus, also known as the Meadow saffron). Originally used to treat rheumatic complaints and especially gout, it was also prescribed for its cathartic and emetic effects. ... Eosinophil granulocyte Basophil granulocyte Granulocytes are a category of white blood cells characterised by the presence of granules in their cytoplasm. ... In medicine, diarrhea, also spelled diarrhoea (see spelling differences), refers to frequent loose or liquid bowel movements. ... For other uses, see Nausea (disambiguation). ...

A randomized controlled trial found similar benefit from nonsteroidal anti-inflammatory drugs and oral glucocorticoids; however, less adverse drug reactions occurred in the glucocorticoids group.^[15] In the nonsteroidal anti-inflammatory drugs group, each patient initially received diclofenac (75 mg) intramuscularly, indomethacin 50 mg orally, and acetaminophen 1 g orally. The patient was received a 5-days of indomethacin (50 mg orally every 8 hours for 2 days, followed by indomethacin 25 mg every 8 hours for 3 days), and acetaminophen 1 g every 6 hours as needed. The glucocorticoids patients received prednisolone 30 mg orally, and acetaminophen 1 g orally. The patient was then given prednisolone 30 mg orally once per day for five days. A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicines or medical procedures. ... Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAIDs, are drugs with analgesic, antipyretic and anti-inflammatory effects - they reduce pain, fever and inflammation. ... The name glucocorticoid derives from early observations that these hormones were involved in glucose metabolism. ... An adverse drug reaction (abbreviated ADR) or adverse drug event (abbreviated ADE) is an expression that describes the unwanted, negative consequences associated with the use of given medications. ... The name glucocorticoid derives from early observations that these hormones were involved in glucose metabolism. ... Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAIDs, are drugs with analgesic, antipyretic and anti-inflammatory effects - they reduce pain, fever and inflammation. ... my sister died form overdose!!! Diclofenac (marketed as Voltaren, Voltarol, Diclon, Dicloflex Difen, Difene, Cataflam, Pennsaid, Rhumalgan, Modifenac, Abitren and Zolterol) is a non-steroidal anti-inflammatory drug (NSAID) taken to reduce inflammation and an analgesic reducing pain in conditions such as in arthritis or acute injury. ... Indomethacin (USAN) or indometacin (INN) is a non-steroidal anti-inflammatory drug commonly used to reduce fever, pain, stiffness, and swelling. ... Acetaminophen (USAN) or paracetamol (INN), is a popular analgesic and antipyretic drug that is used for the relief of fever, headaches, and other minor aches and pains. ... The name glucocorticoid derives from early observations that these hormones were involved in glucose metabolism. ... Prednisolone is the active metabolite of prednisone. ...

Before medical help is available, some over-the-counter medications can provide temporary relief from pain and swelling. NSAIDs such as ibuprofen can reduce the pain and inflammation slightly, although aspirin should not be used as it can worsen the condition. Preparation H hemorrhoidal ointment can be applied to the swollen skin to reduce the swelling temporarily. Professional medical care is needed for long-term management of gout. Ibuprofen (INN) (IPA: ) (from the earlier nomenclature iso-butyl-propanoic-phenolic acid) is a non-steroidal anti-inflammatory drug (NSAID) originally marketed as Nurofen and since under various trademarks, including Act-3, Advil, Brufen, Dorival, Herron Blue, Panafen, Motrin, Nuprin and Burana (Finland), Ipren or Ibumetin (Denmark and Sweden), Ibuprom... This article is about the drug. ... This article does not cite any references or sources. ... Hemorrhoids (AmE), haemorrhoids (BrE), emerods, or piles are varicosities or swelling and inflammation of veins in the rectum and anus. ... An ointment is a viscous semisolid preparation used topically on a variety of body surfaces. ...

Ice may be applied for 20 to 30 minutes several times a day, and a randomized controlled trial found that patients who used ice packs had better relief of pain without side effects.^[16] Since gout is caused by crystals, it has been suggested that keeping very well hydrated and heating the affected joint in hot water (rather than cooling with ice) will promote the dissolution and clearance of the urate crytals.^[17] Keeping the affected area elevated above the level of the heart also may help. A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicines or medical procedures. ... Crystal (disambiguation) Insulin crystals A crystal is a solid in which the constituent atoms, molecules, or ions are packed in a regularly ordered, repeating pattern extending in all three spatial dimensions. ... Uric Acid Uric acid is an organic compound of carbon, nitrogen, oxygen and hydrogen, with the formula C5H4N4O3 It is a minor end-product of nitrogen metabolism in the human body (the main product being urea), and is found in small amounts in urine. ...

Due to swelling around affected joints for prolonged periods, shedding of skin may occur. This is particularly evident when small toes are affected and may promote fungal infection in the web region if dampness occurs, and treatment is similar to that for common athlete's foot. Athletes foot or Tinea pedis[1] is a parasitic fungal infection of the epidermis of the foot. ...

Some sufferers of gout report an aggravation of the condition in the knees and toes associated with long periods of immobility, such as when sitting at a computer desk for long hours. Sufferers who notice early swelling or early pain may appear to be able to arrest the aggravation when medical treatment is applied before the condition gets worse. Where this is the case, a medically prescribed anti-inflammatory oral treatment taken with food and bed rest may provide relief within 6 to 8 hours. Bed rest is a doctors prescription to spend a longer period of time in bed. ...

Another possibility is use of acetazolamide, one of the first diuretics discovered. This drug inhibits the action of carbonic anhydrase on the proximal convoluted tubules within the kidneys, which effectively inhibits reabsorption of bicarbonate, thus alkalinizing the urine. After two to three days of usage, the diuretic effects of this drug decline because of increased downstream reabsorption of ions and water by the renal tubules; however, the alkalinization of urine persists, and this basic urine attracts weak acids such as uric acid and cystine into the urine, thus increasing their urinary excretion.³⁵ Acetazolamide, sold under the trade name Diamox®, is a carbonic anhydrase inhibitor that is used to treat glaucoma, epileptic seizures, benign intracranial hypertension and altitude sickness. ... For baking soda, see Sodium bicarbonate In inorganic chemistry, a bicarbonate (IUPAC-recommended nomenclature: hydrogencarbonate) is an intermediate form in the deprotonation of carbonic acid. ...

Chronic joint changes

For extreme cases of gout, surgery may be necessary to remove large tophi and correct joint deformity.

Prevention

Medications

• Allopurinol is a xanthine-oxidase inhibitor, widely used in the prevention of attacks of gout, and well tolerated. It is safe to use in patients with renal impairment and urate stones.^[18]

• Sulfinpyrazone is an uricosuric. It is less widely used than allupurinol, and must not be used in patients with renal impairment, or a high urate excretion rate.^[19]

• Allopurinol and azathioprine (Imuran) used together present a risk of a potentially fatal drug interaction, a severe risk of allopurinol use which is of importance to transplant patients being treated with azathioprine for immunosuppression.[1]

• Febuxostat ((2-[3-cyano-4-isobutoxyphenyl]-4-methylthiazole-5-carboxylic acid) - a non-purine inhibitor of xanthine oxidase seems to be an alternative that is superior to allopurinol at reducing serum urate levels, but not at reducing attacks of gout; it is currently in Phase III trials.^[20]

• Probenecid, a uricosuric drug that promotes the excretion of uric acid in urine, is also commonly prescribed - often in conjunction with colchicine. The drug fenofibrate (which is used in treating hyperlipidemia) also exerts a beneficial uricosuric effect.^[21]

• As arterial hypertension quite often coexists with gout, treating it with losartan, an angiotensin II receptor antagonist, might have an additional beneficial effect on uric acid plasma levels. This way losartan can offset the negative side-effect of thiazides (a group of diuretics used for high blood pressure) on uric acid metabolism in patients with gout.

• It is suspected that in many cases gout may be secondary to untreated sleep apnea, when oxygen-starved cells break down and release purines as a by-product. Treatment for apnea can be effective in lessening incidence of acute gout attacks.^[22]

• A study in 2004 suggests that animal flesh sources of purine, such as beef and seafood, greatly increase the risk of developing gout. However, high-purine vegetable sources did not. Dairy products such as milk and cheese significantly reduced the chances of gout. The study followed over 40000 men over a period of 12 years, in which 1300 cases of gout were reported.^[23]

• PEG-uricase, a polyethylene glycol ("PEG") conjugate of recombinant porcine uricase (urate oxidase), which breaks down the uric acid deposits is being studied in Phase III clinical trials for the treatment of severe, treatment-refractory gout in the United States in 2006.Pipeline

• Sodium bicarbonate (baking soda) is an old remedy,^[24] thought to work by raising blood pH (lowering blood acidity). However, the added sodium may be inappropriate for some people.

• Ethylenediaminetetraacetic acid, a chelator of lead, has successfully increased uric acid excretion.^[25] This should be an advantageous treatment for those people whose gout was caused by lead poisoning. Care should be taken to increase intake of trace essential elements since chelation often remove these elements also.

• Gout can be triggered by the same agents that cause potassium losses such as fasting, surgery, and potassium losing diuretics.^[26] A potassium deficiency can increase urate levels in the blood.^[27] So potassium supplements should be advantageous to treat gout.

• Research from the University of British Columbia suggests long-term coffee consumption is associated with a lower risk of gout. ^[28][29]

Allopurinol is a drug used primarily to treat conditions arising from excess uric acid, most notably chronic gout. ... Sulfinpyrazone is a uricosuric medication used to treat gout. ... Allopurinol is a drug used primarily to treat conditions arising from excess uric acid, most notably chronic gout. ... Azathioprine is a chemotherapy drug, now rarely used for chemotherapy but more for immunosuppression in organ transplantation, autoimmune disease such as rheumatoid arthritis or inflammatory bowel disease such as Crohns disease. ... Azathioprine is a chemotherapy drug, now rarely used for chemotherapy but more for immunosuppression in organ transplantation, autoimmune disease such as rheumatoid arthritis or inflammatory bowel disease such as Crohns disease. ... A drug interaction is a situation in which a substance affects the activity of a drug, i. ... Immunosuppression is the medical suppression of the immune system. ... Febuxostat is an inhibitor of xanthine oxidase currently under investigation as a potential treatment for gout. ... In medicine, a clinical trial (synonyms: clinical studies, research protocols, medical research) is a research study. ... Probenecid is a uricosuric drug, primarily used in treating gout or hyperuricemia, that increases uric acid removal in the urine. ... Colchicine is a highly deadly poisonous alkaloid, originally extracted from plants of the genus Colchicum (Autumn crocus, also known as the Meadow saffron). Originally used to treat rheumatic complaints and especially gout, it was also prescribed for its cathartic and emetic effects. ... Fenofibrate is a drug of the fibrate class. ... Hypercholesterolemia (literally: high blood cholesterol) is the presence of high levels of cholesterol in the blood. ... Losartan (rINN) (IPA: ) is an angiotensin II receptor antagonist drug used mainly to treat high blood pressure (hypertension). ... Losartan, the first ARB Angiotensin II receptor antagonists, also known as angiotensin receptor blockers (ARBs), AT1-receptor antagonists or sartans, are a group of pharmaceuticals which modulate the renin-angiotensin-aldosterone system. ... Thiazides are a class of drug that promote water loss from the body ((diuretics)). They inhibit Na+/Cl- reabsorption from the distal convoluted tubules in the kidneys. ... This illustration shows where some types of diuretics act, and what they do. ... Arterial hypertension, or high blood pressure is a medical condition where the blood pressure is chronically elevated. ... Sleep apnea is a sleep disorder characterized by pauses in breathing during sleep. ... This box:      In health care, a clinical trial is a comparison test of a medication or other medical treatment (such as a medical device), versus a placebo (inactive look-a-like), other medications or devices, or the standard medical treatment for a patients condition. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... Flash point Non-flammable. ...

Diet

See Saag and Choi, 2006, an open-access review article, for detailed references and further information.^[30]

The serum level of uric acid is the primary risk factor for gout. The serum level is the result of both intake (diet) and output (excretion). Diet should be low fat and low protein.

Reduce intake of purines

The solubility threshold for uric acid is approximately 6.7 mg/dl; above this threshold crystals may form. Healthy subjects in the Normative Aging Study who had serum levels of uric acid over 9.0 mg/dl suffered a 22% incidence of gout over six years, compared to less than one percent for those with 7.0-8.9 mg/dl. The average uric acid level in men is 5.0 mg/dl, and substitution of a purine-free formula diet reduces this to 3.0 mg/dl. A purine-restricted diet lowers the level nearly as much (1-2 mg/dl).

A diet low in purines reduces the serum level of uric acid, unless these levels are caused by other health conditions and not as responsive to dietary changes. For notable sources of dietary purines, see "Foods to avoid" section below.

Protein is a crude proxy for purines; a more precise proxy is muscle. Apart from the notable dietary purines above, the main source of dietary purines is DNA and RNA, via their bases adenine and guanine. All sources of dietary protein supply some purines, but some sources provide far more purines than others. Meat (particularly dark meat) and seafood are high in purine because muscle cells are packed with mitochondria, which have their own DNA and RNA. In a large prospective study, high consumption of meat and seafood were found associated with an elevated risk of gout onset (41% and 50%, respectively). High consumption of dairy products, high in protein but very low in DNA and RNA, was associated with a 44% decrease in the incidence of gout. Consumption of the more purine-rich vegetables or a high protein diet per se had no significant correlation. The structure of part of a DNA double helix Deoxyribonucleic acid, or DNA, is a nucleic acid molecule that contains the genetic instructions used in the development and functioning of all known living organisms. ... For other uses, see RNA (disambiguation). ... For the programming language Adenine, see Adenine (programming language). ... Guanine is one of the five main nucleobases found in the nucleic acids DNA and RNA; the others being adenine, cytosine, thymine, and uracil. ... For other uses of Muscles, see Muscles (disambiguation). ... Electron micrograph of a mitochondrion showing its mitochondrial matrix and membranes In cell biology, a mitochondrion (plural mitochondria) is a membrane-enclosed organelle that is found in most eukaryotic cells. ...

Men who consume two or more sugary soft drinks a day have an 85% higher risk of gout compared with those who drink less than one a month. [2]

Consumption of beer is associated with a 49% increase in relative risk per daily 12-oz serving. By contrast, consumption of spirits was associated with only a 15% increase in relative risk, and no association at all was found with consumption of wine. Spirits redirects here. ...

Some medical drugs are purine-based. Notable among these are the purine-analog antimetabolite drugs, sometimes used as chemotherapy agents. An antimetabolite is a chemical with a similar structure to a substance (a metabolite) required for normal biochemical reactions, yet different enough to interfere with the normal functions of cells, including cell division. ... Chemotherapy, in its most general sense, refers to treatment of disease by chemicals that kill cells, specifically those of micro-organisms or cancer. ...

Increase output of uric acid

Other approaches

Additional dietary recommendations can be made which reduce gout indirectly, hypertension, cardiovascular disease, diabetes, and metabolic syndrome. For other forms of hypertension, see Hypertension (disambiguation). ... Cardiovascular disease refers to the class of diseases that involve the heart or blood vessels (arteries and veins). ... This article is about the disease that features high blood sugar. ... Metabolic syndrome is a combination of medical disorders that increase ones risk for cardiovascular disease and diabetes. ...

The following suggestions do not meet with universal approval among medical practitioners.

Low purine diet: Purine (1) is a heterocyclic aromatic organic compound, consisting of a pyrimidine ring fused to an imidazole ring. ...

• To lower uric acid:
  • bing cherries were reported to reduce uric acid in a small study.^[31][32]
  • celery extracts (celery or celery seed either in capsule form or as a tisane/infusion) is believed by many to reduce uric acid levels (although these are also diuretics).^{[citation needed]} Celery extracts have been reported to act synergistically with anti-inflammatory drugs.^[33]
  • Cheese has been recommended as a low-purine food,^[34] and dairy products have been found to reduce the risk of gout.
  • Carbonated beverages and sugar have also been recommended as a low-purine food, ^[35] even though it was established that men who consume two or more sugary soft drinks a day have an 85% higher risk of gout compared with those who drink less than one a month. [3]
• Food to avoid:
  • foods high in purines
    • limit food high in protein such as meat, fish, poultry, or tofu to 8 ounces (226 grams) a day. Avoid entirely during a flare up.^{[citation needed]} Tofu has been proposed as a safe source of protein for gout patients due to its small and transient effect on plasma urate levels.^[36]
    • sweetbreads, kidneys, liver, brains, or other offal meats.^[37][38]
    • sardines and anchovies^[39]
    • seafood^[40]
    • Asparagus. Cauliflower. Mushrooms. Spinach. (Even though above says "Consumption of the more purine-rich vegetables or a high protein diet per se had no significant correlation.")
    • Dry beans (lentils & peas).
    • alcohol.^[41] Some claim that this applies especially to beer (high in guanosine), on the basis that brewer's yeasts are very rich in purine. Since most modern commercial beer contains only trace amounts of yeast, this claim requires further substantiation.^{[citation needed]} Formerly, port wine was sweetened with litharge, causing lead poisoning, of which gout is a complication. Ironically, red wines, particularly those produced by traditional methods,^[42] contain procyanidins released from grape seeds during wine making, which have been reported to lower serum uric acid levels by an indirect mechanism.^[43] However, withdrawal of urate-lowering therapy is associated with recurrence of acute gouty arthritis.^[44]
    • meat extracts, consommés, and gravies^[45]

• To avoid dehydration:
  • Drink plenty of liquids, especially water, to dilute and assist excretion of urates;
  • Avoid diuretic foods or medicines like aspirin(aspirin should be avoided by those suffering from gout, unless specified by a qualified physician), vitamin C, tea and alcohol. The role of diuretics in triggering gout has been disputed.^[46]

• Moderate intake of purine-rich vegetables is not associated with increased gout.^[23]

Branch of a Bing cherry tree Bing in what is now Milwaukie, Oregon. ... Binomial name L. Percentages are relative to US recommendations for adults. ... This illustration shows where some types of diuretics act, and what they do. ... Purine (1) is a heterocyclic aromatic organic compound, consisting of a pyrimidine ring fused to an imidazole ring. ... For other uses, see Meat (disambiguation). ... For other uses, see Fish (disambiguation). ... Ducks amongst other poultry The Poultry-dealer, after Cesare Vecellio Poultry is the category of domesticated birds kept for meat, eggs, and feathers. ... For other uses, see Tofu (disambiguation). ... Sweetbread is the name of a dish made of the pancreas (belly/stomach) or thymus gland (neck/throat/gullet/heart sweetbread) of an animal younger than one year old. ... The kidneys are the organs that filter wastes (such as urea) from the blood and excrete them, along with water, as urine. ... The liver is the largest internal organ in the human body, and is an organ present in vertebrates and some other animals. ... For other uses, see Brain (disambiguation). ... Scrapple sandwich at the Delaware state fair Offal is the entrails and internal organs of a butchered animal. ... Sardines in the Pacific An open Sardines can Sardines on a plate grilled Sardines For the hide and seek-like game, see Hide and seek. ... Genera Amazonsprattus Anchoa Anchovia Anchoviella Cetengraulis Coilia Encrasicholina Engraulis Jurengraulis Lycengraulis Lycothrissa Papuengraulis Pterengraulis Setipinna Stolephorus Thryssa The anchovies are a family (Engraulidae) of small, common salt-water fish. ... Spaghetti with seafood (Spaghetti allo scoglio). ... This article does not cite any references or sources. ... For other uses, see Beer (disambiguation). ... The chemical structure of Guanosine Guanosine is a nucleoside comprising guanine attached to a ribose (ribofuranose) ring via a β-N9-glycosidic bond. ... Brewers yeast (also known as brewers yeast or brewing yeast) can mean any live yeast used in brewing. ... A glass of tawny port. ... Litharge is the natural mineral form of lead(II) oxide, PbO. Litharge is a secondary mineral which forms from the oxidation of galena ores. ... Lead poisoning is a medical condition, also known as saturnism, plumbism, or painters colic caused by increased blood lead levels. ... Proanthocyanidin (also known as oligomeric proanthocyanidin (OPC), pycnogenol, leukocyanidin and leucoanthocyanin) is a class of flavonoids. ... Grow and harvest grapes. ... This article does not cite any references or sources. ... For other uses, see Gravy (disambiguation). ... Dehydration (hypohydration) is the removal of water (hydro in ancient Greek) from an object. ... Impact from a water drop causes an upward rebound jet surrounded by circular capillary waves. ... This illustration shows where some types of diuretics act, and what they do. ... This article is about the drug. ... This article is about the nutrient. ... For other uses, see Tea (disambiguation). ...

History

Writing ca. 30 AD, Aulus Cornelius Celsus appeared to recognize many of the features of gout, including its link with a urinary solute, late onset in women, linkage with alcohol, and perhaps even prevention by dairy products. [4] "Again thick urine, the sediment from which is white, indicates that pain and disease are to be apprehended in the region of joints or viscera." and "Joint troubles in the hands and feet are very frequent and persistent, such as occur in cases of podagra and cheiragra. These seldom attack eunuchs or boys before coition with a woman, or women except those in whom the menses have become suppressed. Upon the commencement of pain blood should be let; for when this is carried out at once in the first stages it ensures health, often for a year, sometimes for always. Some also, when they have washed themselves out by drinking asses' milk, evade this disease in perpetuity; some have obtained lifelong security by refraining from wine, mead and venery for a whole year; indeed this course should be adopted especially after the primary attack, even although it has subsided." Aulus Cornelius Celsus Aulus Cornelius Celsus (25 BC—50) was a Roman encyclopedist and possibly, although not likely, a physician. ...

The Roman gladiatorial surgeon Galen described gout as a discharge of the four humors of the body in unbalanced amounts into the joints. The Latin term for a drop, as a drop of discharge, is gutta -- the term gout descends from this word. Ancient Rome was a civilization that grew from a small agricultural community founded on the Italian Peninsula circa the 9th century BC to a massive empire straddling the Mediterranean Sea. ... For other uses, see Galen (disambiguation). ... This article needs additional references or sources for verification. ... For other uses, see Latins and Latin (disambiguation). ...

One of the most famous sufferers of gout was Henry VIII. Others include Colin Barns, John Calvin, Charles Spurgeon, Kublai Khan, Nostradamus, Christopher Columbus, John Milton, Queen Anne, Isaac Newton, Gottfried Leibniz, Henry Fielding, Samuel Johnson, Charles IV, Holy Roman Emperor, Charles V, Holy Roman Emperor,^[47] Pablo Neruda, Alfred Lord Tennyson, George IV, John Hancock, Thomas Jefferson, Jeff Mullis, Karl Marx, William Pitt, 1st Earl of Chatham, Benjamin Disraeli, Kirk Rueter, Peter Paul Rubens, Osbert Sitwell, Lennart Torstenson, Peter Gomes, Alexander Hamilton, George Mason, Benjamin Franklin, Wilkie Collins, Henry James, Frederick the Great, Raven, Don Nelson, Jared Leto, Pope Clement VIII, Bobby Hill, Sir Laurence Olivier, David Wells, Joseph Conrad, Curt Schilling , Harry Judd, Roe Conn and Guy Debord. Henry VIII redirects here. ... John Calvin (July 10, 1509 – May 27, 1564) was a French Protestant theologian during the Protestant Reformation and was a central developer of the system of Christian theology called Calvinism or Reformed theology. ... Charles Haddon Spurgeon, commonly C.H. Spurgeon, (June 19, 1834 – January 31, 1892) was a British Reformed Baptist preacher who remains highly influential amongst Christians of different denominations, among whom he is still known as the Prince of Preachers. ... For other uses, see Kublai Khan (disambiguation). ... Nostradamus: original portrait by his son Cesar Michel de Nostredame (December 14, 1503 – July 2, 1566), usually Latinized to Nostradamus, was a French apothecary and reputed seer who published collections of prophecies that have since become famous world-wide. ... Christopher Columbus (1451 – May 20, 1506) was a navigator, colonizer, and explorer and one of the first Europeans to explore the Americas after the Vikings. ... For other persons named John Milton, see John Milton (disambiguation). ... Anne (6 February 1665 – 1 August 1714) became Queen of England, Scotland and Ireland on 8 March 1702, succeeding William III of England and II of Scotland. ... Sir Isaac Newton FRS (4 January 1643 – 31 March 1727) [ OS: 25 December 1642 – 20 March 1727][1] was an English physicist, mathematician, astronomer, natural philosopher, and alchemist. ... Leibniz redirects here. ... Henry Fielding (April 22, 1707 – October 8, 1754) was an English novelist and dramatist known for his rich earthy humor and satirical prowess and as the author of the novel Tom Jones. ... For other persons named Samuel Johnson, see Samuel Johnson (disambiguation). ... Charles IV, Holy Roman Emperor. ... For the Carlist claimant King Carlos V, see Infante Carlos, Count of Molina. ... Pablo Neruda (July 12, 1904 – September 23, 1973) was the penname and, later, legal name of the Chilean writer and communist politician Ricardo Eliecer Neftalí Reyes Basoalto. ... Lord Tennyson, Poet Laureate Alfred Tennyson, 1st Baron Tennyson (August 6, 1809 - October 6, 1892) is generally regarded as one of the greatest English poets. ... George IV redirects here. ... John Hancock (January 23 [O.S. January 12] 1737– October 8, 1793) was President of the Second Continental Congress and of the Congress of the Confederation, the first Governor of Massachusetts, and the first person to sign the United States Declaration of Independence. ... Thomas Jefferson (13 April 1743 N.S.–4 July 1826) was the third President of the United States (1801–09), the principal author of the Declaration of Independence (1776), and one of the most influential Founding Fathers for his promotion of the ideals of Republicanism in the United States. ... This article or section is not written in the formal tone expected of an encyclopedia article. ... Karl Heinrich Marx (May 5, 1818 – March 14, 1883) was a 19th century philosopher, political economist, and revolutionary. ... William Pitt, 1st Earl of Chatham PC (15 November 1708 – 11 May 1778) was a British Whig statesman who achieved his greatest fame as Secretary of State during the Seven Years War (known as the French and Indian War in North America) and who was later Prime Minister of Great... Benjamin Disraeli, 1st Earl of Beaconsfield (December 21, 1804 - April 24, British Conservative Prime Minister of the United Kingdom and author. ... Kirk Wesley Rueter (born December 1, 1970 in Hoyleton, Illinois), nicknamed Woody after a character in the animated movie Toy Story, is a left-handed pitcher in Major League Baseball for the San Francisco Giants. ... Peter Paul Rubens (June 28, 1577 – May 30, 1640) was a prolific seventeenth-century Flemish and European painter, and a proponent of an exuberant Baroque style that emphasized movement, color, and sensuality. ... Sir Francis Osbert Sacheverell Sitwell, 5th Baronet, (December 6, 1892 – May 4, 1969) was an English writer. ... Count Lennart Torstenson (August 17, 1603 - April 7, 1651) was a Swedish soldier and military engineer and the son of Torsten Lennartson, commandant of Älvsborg Fortress. ... Peter John Gomes is a prominent African American preacher and theologian at Harvard Universitys Divinity School. ... Alexander Hamilton (November 20, 1755 or 1757 - July 12, 1804) was the first Secretary of the Treasury of the United States, lawyer, Founding Father, American politician, leading statesman, political economist,] financier, and political theorist. ... For other persons named George Mason, see George Mason (disambiguation). ... Benjamin Franklin (January 17 [O.S. January 6] 1706 – April 17, 1790) was one of the most well known Founding Fathers of the United States. ... Wilkie Collins William Wilkie Collins (8 January 1824 – 23 September 1889) was an English novelist, playwright, and writer of short stories. ... For other uses of this name, see Henry James (disambiguation). ... Frederick the Great Frederick II of Prussia (Friedrich der Große, Frederick the Great, January 24, 1712 – August 17, 1786) was the Hohenzollern king of Prussia 1740–86. ... Scott Anthony Levy (born September 8, 1964) better known by his ring name Raven, is an American professional wrestler. ... Donald Arvid Nelson (born May 15, 1940 in Muskegon, Michigan) is an NBA head coach. ... Jared Joseph Leto (born December 26, 1971) is an American actor and musician. ... Pope Clement VIII (Fano, Italy, February 24, 1536 – March 3, 1605 in Rome), born Ippolito Aldobrandini, was Pope from January 30, 1592 to March 3, 1605. ... Bobby Hill is a common personal name that can refer to different people: Bobby Hill (baseball player) Bobby Hill (Cartoon character in King of the Hill) This is a disambiguation page — a navigational aid which lists pages that might otherwise share the same title. ... Laurence Olivier, as photographed in 1939 by Carl Van Vechten Laurence Kerr Olivier, Baron Olivier, OM (May 22, 1907 – July 11, 1989) was an English actor and director, esteemed by many as the greatest actor of the 20th century. ... This article is about David Wells, American baseball player. ... // Joseph Conrad (born Józef Teodor Konrad Korzeniowski; 3 December 1857 – 3 August 1924) was a Polish-born English novelist. ... Curtis Montague (Curt) Schilling (born November 14, 1966 in Anchorage, Alaska) is an American Major League Baseball right-handed starting pitcher for the Boston Red Sox. ... Harry Mark Christopher Judd,[1] commonly known as Harry Judd (born December 23, 1985 in Chelmsford, Essex, England) is the drummer in the British pop band McFly, along with fellow band members Tom Fletcher, Dougie Poynter and Danny Jones. ... Roe B. Conn (born in Chicago on 6 June 1964) is an American radio talk show host who is the host of The Roe Conn Show which airs on WLS-AM 890 in Chicago, Illinois. ... Guy Ernest Debord (December 28, 1931, in Paris – November 30, 1994, in Champot) was a writer, film maker, hypergraphist and founding member of the groups Lettrist International and Situationist International (SI). ...

See also

• Pseudogout is a very similar disease, but caused by deposition of calcium pyrophosphate, not uric acid.

It has been suggested that this article or section be merged with Calcium pyrophosphate deposition disease. ... Calcium pyrophosphate Ca2P2O7 is a chemical compound that can be formed by the reaction of Pyrophosphoric acid and a calcium base or by strongly heating calcium hydrogen orthophosphate or calcium ammonium orthophosphate. ...

References

35.) Katzung, Bertram G. Basic and Clinical Pharmacology, 10th edition. New York: McGraw Hill Medical, 2007. pp. 242 The British Medical Journal (BMJ) is a medical journal published weekly in the United Kingdom by the British Medical Association (BMA)which published its first issue in 1845. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 26th day of the year in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 270th day of the year (271st in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 270th day of the year (271st in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ...

External links

• American College of Rheumatology (March 23, 2007). Retrieved on 2007-03-23.- (ACR Fact Sheet on Gout)
• Answers and Questions on Gout. U.S. National Institutes of Health—National Institute of Arthritis and Musculoskeletal and Skin Diseases (September 28, 2007). Retrieved on 2007-08-28.
• Diet and gout. A-Z Health Guide. webMD.com (July 1, 2004). Retrieved on 2006-09-18.
• Coffee Consumption and Reduced Gout Risk. Drinking coffee reduces risk of gout in middle age men. U.S. National Institutes of Health. Retrieved on 2007-05-25.
• Purine content in food. British Dalmatian Club. Retrieved on 2006-09-18.
• Gout in Depth - How Stuff Works