Gout is the most common form of inflammatory arthritis in men past the age of 40. It is a metabolic condition due to an over-accumulation of uric acid. This situation occurs because of two factors. The first is an inability to excrete uric acid fast enough. The second is an overproduction of uric acid which is a byproduct of the metabolism of foods containing a substance called purines.
As one might imagine this process develops over time. Uric acid accumulates to the point where there is oversaturation of the substance in joint fluid and other body tissues. This oversaturation eventually causes deposits of monosodium urate to accumulate. Over the course of many years, these crystals form deposits called "microtophi" which are a mixture of monosodium urate, fibrous tissue, and different kinds of inflammatory cells. Theses microtophi form on the surface of the joint lining (synovium) as well as on the cartilage.
When a certain critical point is reached, the first gout attack occurs. This is the beginning of the phase termed "acute intermittent gout." Acute attacks are separated by a symptom free-interval. This symptom free interval is called the "intercritical period." The intercritical period can last for months to years.
Even though early gout attacks can be successfully treated, monosodium urate crystals still remain inside joints and cause low grade chronic inflammation. This causes damage to the joints.
As acute intermittent gout continues, the attacks become more frequent and tend to last longer. Other joints may become involved as well. The length of attacks can vary. Mild attacks last between a few hours up to a few days. Severe attacks can last many weeks. Obviously, the quicker the attacks can be diagnosed and treated, the shorter the attacks will last.
As further progression takes place, the intercritical period is no longer symptom free.
This has now become the stage of chronic gout. Patients have chronic stiffness and pain in many joints. When gout affects multiple joints, it can be mimic other types of arthritis. In fact when it affects multiple joints in a symmetric manner, it can be confused with rheumatoid arthritis. Significant joint damage and kidney damage can occur now.
Patients with chronic gout often have other associated conditions such as obesity, elevated blood levels, diabetes, and hypertension. This constellation of co-morbid conditions is referred to as the "metabolic syndrome."
Treatment of gout consists of aborting the acute attack as well as dealing with the consequences of uric acid overload by using medications that can suppress uric acid production.
Nathan Wei, MD, FACP, FACR is a rheumatologist and Director of the Arthritis Treatment Center http://www.arthritistreatmentcenter.com. He is a former Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and consultant to the National Institutes of Health. For more info: http://www.arthritis-treatment-and-relief.com/arthritis-treatment.html
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