An estimated 5.1 million people in the United States live with gout, according to the National Health and Nutrition Examination Survey III, 1988-1994. Gout is the most common form of inflammatory arthritis in men over 40 and affects approximately 3 times as many men as women. The number of newly diagnosed cases has increased over the past 40 years.
Gout is a kind of arthritis that has been known since ancient times. Hippocrates called it “the disease of kings” because of its association with a rich diet. In reality, there are a number of factors that can lead to gout, and diet is part of this larger picture.
The pain of gout (called attacks or flares) is caused by inflammation when needle-like crystals are deposited in connective tissue and/or in the fluid that cushions a joint (the synovial fluid). These crystals are made up of uric acid, a substance produced when the body breaks down purines found in human tissue and many foods we eat. Most uric acid is carried through the bloodstream to the kidneys, which eliminate it from the body in the urine. However, if the body produces too much uric acid or if the kidneys don't eliminate enough of it, uric acid can build up in the blood. This condition is called hyperuricemia and can lead to gout attacks in some cases. However, in most cases, hyperuricemia does not lead to gout.
An attack usually starts with sudden, severe pain, tenderness, redness, warmth, and swelling in the large joint of the big toe. Other joints may include the instep, ankles, heels, knees, wrists, fingers, and elbows. Rarely, the shoulders, hips, or spine may be affected. After about 3-10 days, the attack usually subsides, and the next one may not happen for months or even years. But over time, the gout attacks can become more severe, last longer, affect more than one joint, and occur more often.
Gout can progress, eventually causing damage to joints, potentially leading to disability. However, with proper treatment, most people with gout are able to control their symptoms. Treatment may include different kinds of medication to ease the painful attacks, to prevent future attacks, and to help prevent long-term damage to the joints and related disability.
To learn more about gout, including causes, symptoms, and long-term effects, see the topics within this section. To learn what to do when a gout flare strikes, see How to Cope.
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