Gout is sometimes referred to as the “disease of kings”
because it long has been associated incorrectly
with the kind of overindulgence in food and wine only the rich
and powerful could afford. In fact,
anyone can be affected, and the risk factors are varied.
Fortunately, it is possible to treat gout and
reduce its agonizing attacks by avoiding food triggers and
taking advantage of medication options.
• Intense painful joint swelling, most often in the feet (and
especially the big toe), may indicate
• Treatment options exist, but therapy should be
individualized for each person.
• Avoiding alcohol and certain fish and meats may help prevent
further gout attacks.
What is gout?
Gout is a painful and potentially disabling form of arthritis
that has been recognized since ancient times.
Initial symptoms usually consist of intense episodes of painful
swelling in single joints, most often in the
feet (especially the big toe). Treatments are now available to
control most cases of gout, but diagnosing
this disorder can be difficult, and treatment plans often have
to be tailored for each person.
What causes gout?
Gout occurs when excess uric acid (a normal waste product)
accumulates in the body, and needle‐like
crystals deposit in the joints. This may happen because either
uric acid production increases or, more
often, the kidneys are unable to remove uric acid from the
body adequately. Certain foods, such as
shellfish and alcohol, may increase uric acid levels and lead to
Some medications also can increase uric acid levels. Examples
of such medications include moderatedose
aspirin (81 mg used for prevention of heart attack and stroke
has minimal effect and can generally
be continued), diuretics such as hydrochlorothiazide (Esidrix,
Hydro‐D), and immunosuppressants used
in organ transplantation such as cyclosporine (Neoral,
Sandimmune) and tacrolimus (Prograf).
With time, increased uric acid levels in the blood may lead to
deposits of m