Gout Quiz

Arthritis is a term that is often used to refer to the more than 100 different rheumatic diseases that affect the joints, muscles and bones, and may also affect other connective tissues. Gout accounts for about 5 percent of all cases of arthritis.

Normally, uric acid is dissolved in the blood and passes through the kidneys into the urine, where it is eliminated. If the body increases its production of uric acid or if the kidneys do not eliminate enough uric acid from the body, levels build up. Excess uric acid crystals can build up in the joint spaces, and can also collect in the kidneys and cause kidney stones.

Gout usually initially affects the joints in the big toe, a condition called podagra. Sometime during the course of the disease, gout will affect the big toe in about 75 percent of patients. Gout can also affect the instep, ankles, heels, knees, wrists, fingers and elbows.

The disease can progress through four stages, the last of which can result in permanent damage to the affected joints and sometimes to the kidneys. With proper treatment, however, most people with gout don't progress to this last stage.

An acute attack commonly occurs at night and can be triggered by stressful events, alcohol or drugs, or another acute illness.

Excessive use of alcohol can interfere with the removal of uric acid from the body.

Men are more likely to develop gout than women, and men aged 40 to 50 are most commonly affected. Women rarely develop gout before menopause.

Other symptoms include the presence of uric acid crystals in joint fluid; arthritis that develops in 1 day; and an attack of arthritis in only one joint, usually the toe, ankle, or knee.

Diagnosis is difficult because the symptoms of gout may be vague and often mimic other conditions. To confirm a diagnosis of gout, doctors typically test the fluid in the joint, called synovial fluid, by using a needle to draw a sample of fluid from a person's inflamed joint. The doctor places some of the fluid on a slide and looks for monosodium urate crystals under a microscope. If the person has gout, the doctor will almost always see crystals. Their absence, however, does not completely rule out the diagnosis.

NSAIDs reduce the inflammation caused by deposits of uric acid crystals. Patients usually begin to improve within a few hours of treatment, and the attack goes away completely within a few days.