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Arthritis Treatment: Gout - Disease of Kings or Just a Very Common Type of Arthritis

April 17, 2012 | Comments: 0 | Views: 218

Gout, at one time, was designated the "disease of kings" and was associated with a lifestyle consisting of power, a high station in life, and wealth. In today's world though, that is no longer the case.

As a result of several demographic factors including longer life span, the obesity epidemic, and other conditions often associated with gout including hyperlipidemia (elevated cholesterol and triglycerides), diabetes, and hypertension, gout is recognized as being an extremely common condition. In fact, gout is the most common form of inflammatory arthritis in men past the age of 40.

Gout affects roughly 8 million Americans making it more common than other forms of arthritis such as rheumatoid arthritis, fibromyalgia, and carpal tunnel syndrome.

In addition to hypertension, diabetes, and elevated lipids, gout patients are often affected by diseases affecting the cardiovascular system as well as the kidneys. The role of increased alcohol consumption also cannot be ignored.

Gout is caused by the deposition of monosodium urate crystals (uric acid). This happens because the body is unable to get rid of this compound via the kidneys at a fast enough rate to keep pace with production of monosodium urate that arises as a result of the metabolism of purines, a constituent found in many foods.

The first sign of a potential gouty problem is termed "asymptomatic hyperuricemia." This means that a patient has an elevated blood uric acid level but no symptoms. There is still debate as to when and if to treat this condition.

The next episode is usually an attack of acute gout. While these attacks can be managed symptomatically, acute gout is usually a prelude to another attack of acute gout. The period between acute gout attacks is called the "intercritical period."

During this time monosodium urate deposits accumulate in joints and other organs such as the kidneys.

These crystals cause a chronic low grade inflammation that leads to joint and organ damage.

If gout is not treated at this juncture, it evolves into "chronic gouty arthritis" with attendant joint destruction, pain, and loss of function.

While much has been written about diet in gout, the fact of the matter is that gout is a metabolic disorder that needs to be treated with medication. Dietary manipulation may reduce uric acid levels only by about 1mg/dl.

Because laboratory ranges are based on "normal populations", the trend has been to see normal levels that are much higher than the past. The fact is all gout patients need to have their serum uric acid kept below 6mg/dl.

Nathan Wei, MD, FACP, FACR is a rheumatologist and Director of the Arthritis Treatment Center 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:

Source: EzineArticles
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