Gout is an inflammatory disease caused by the deposition of monosodium urate crystals in synovial joints. These crystals are formed due to hyperuricemia – high levels of uric acid (a waste product of degradation of DNA) in the body – which is caused by either a greater rate of synthesis or impaired excretion of uric acid. Hyperuricemia can also be caused by consuming a diet rich in seafood or red meat.
The first joint to the affected is the first metatarsophalangeal joint (the joint of the big toe), followed by ankle, midfoot, knee, wrist, hand, and elbow joints. It causes acute and severe pain, often described by patients as the “worst pain ever” as well as swelling and tenderness in the affected area. Episodes of gout are usually self-limiting and tend to resolve in 5 to 14 days. Chronic gout can cause functional impairment and the formation of nodules called “tophi” in the joints involved.
The symptoms of gout are usually managed with oral non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief and ice packs to relieve swelling. The drug of choice to lower uric acid levels is allopurinol, although oral colchicine is also very effective. A urate-lowering therapy is suitable for people experiencing more than one gout attack in 12 months.