Gout — guide.

What is gout

Gout is a form of inflammatory arthritis caused by the deposition of monosodium urate crystals in the joints and surrounding tissues. The underlying mechanism is hyperuricemia — an elevated level of uric acid in the blood — which results either from overproduction or, more often, from deficient renal excretion. It predominantly affects men after the age of 40 and women after menopause. Risk factors include a diet rich in purines, alcohol consumption (especially beer), obesity, hypertension, kidney disease and certain medications (diuretics, low-dose aspirin).

The acute attack

The typical attack begins suddenly, frequently at night, with severe pain in a single joint — classically at the base of the big toe (podagra). The joint becomes swollen, red, warm and extremely tender, so that even the weight of a bedsheet becomes unbearable. Untreated, the attack lasts 3-10 days. Over time, without treatment, attacks become more frequent, affect more joints, and tophi — visible deposits of crystals under the skin — may appear.

Attack treatment (Rx)

• NSAIDs — ibuprofen 800 mg x 3, naproxen or another anti-inflammatory at full dose.
• Colchicine, more effective if started within the first hours.
• Oral or injected corticosteroids, when NSAIDs are contraindicated.

Prophylactic (Rx)

• Allopurinol 100-600 mg/day, introduced after the acute attack has subsided.
• Febuxostat as an alternative in case of allopurinol intolerance.

Therapeutic target: uric acid below 6 mg/dl (below 5 mg/dl in those with tophi).

Diet

• Avoid red meat, organ meats, seafood, beer and fructose-containing drinks.
• Hydration 2-3 l/day to promote urate elimination.
• Limiting fructose and alcohol; low-fat dairy and coffee appear to be protective.

OTC and supplements

• Cherry extract 1-3 g/day — reduces the frequency of attacks.
• Vitamin C 500-1000 mg/day — slightly lowers uric acid.
• Omega-3 with an anti-inflammatory role.

Medical disclaimer: the information in this guide is for informational purposes only and does not replace the advice of a doctor or pharmacist. For diagnosis and treatment, consult a health professional.