Gout is a painful condition that occurs when the bodily waste product uric acid is deposited as needle-like crystals in the joints and/or soft tissues. In the joints, these uric acid crystals cause inflammatory arthritis, which in turn leads to intermittent swelling, redness, heat, pain, and stiffness in the joints.
In many people, gout initially affects the joints of the big toe (a condition called podagra). But many other joints and areas around the joints can be affected in addition to or instead of the big toe. These include the insteps, ankles, heels, knees, wrists, fingers, and elbows. Chalky deposits of uric acid, also known as tophi, can appear as lumps under the skin that surrounds the joints and covers the rim of the ear. Uric acid crystals can also collect in the kidneys and cause kidney stones.

I didn't need any more evidence that my best days are behind me, but if I did, I now have it.
It's gout, which has me dragging my left foot around like a pig-headed puppy on a leash. I had heard of gout before it was mine, but never knew what it was, except that it made painful the joints of - here's the part that is hard for me to accept - old folks.

Really, really painful, I have learned. So painful that I turn off the ceiling fan when I go to bed at night because the breeze feels like a kick. If you want to feel my pain, take a nail and pound it though the joint that connects the left big toe to the rest of the foot. And leave it there for several days.

I am told that there is a pill I can take every day that will get control the gout, but I don't like pills, so I am going with more water and berries, and less red meat and other protein. If it turns out that a Corona Light is to blame, then I will head to CVS.
This bout with gout got me reflecting on what I have managed by staying alive, and that is to grow periously close to being

A RESEARCH project into the causes of gout among East Coast patients, particularly Maori, could bear fruit sooner rather than later, scientists say.
"We believe that this is a situation where, rather than conducting the research then looking for solutions, the solutions in terms of medication are already out there," said Tony Merriman, of the University of Otago’s biochemistry unit.

"What we hope to do by pinpointing the reasons behind the high incidence of gout, especially in Maori men, is to help doctors make decisions about what they prescribe, and for who."
Dr Merriman and genetic research associate Jade Hollis-Moffatt have spent the past week on the East Coast. As well as meeting with community groups and clinical staff in Ruatoria, Tokomaru Bay, Tolaga Bay and Gisborne, they have been in talks with health agency Ngati Porou Hauroa (NPH).

"It was very interesting to talk to people about their experiences with gout, or the experiences of friends or whanau," Dr Merriman said.
"It seems that, whoever you talk to, they have gout or know someone that does."
With the population on the Coast being predominantly Maori, the high incidence of gout did not surprise the researchers.

They already knew that, in New Zealand, gout affected more than 10 percent of Maori men and about 3 percent of women (compared to 1 to 2 percent of Caucasian men). For Pacific Islanders, the figures were even worse — over 15 percent of Pacific Island men suffered from gout in their lifetimes.
The effects can, quite literally, be crippling. Caused by an excess of uric acid metabolism, the condition takes the form of painful swelling of the joints that can become chronic and result in deformity.

Now that they have background information about gout on the Coast, the researchers plan to put a proposal to NPH, whereby the health agency identifies patients diagnosed with gout and invites them to be part of the study.

If NPH approves the project, the next step would be to seek funding to pay for a nurse to administer the project from the Gisborne end.
"What we envisage is having someone who can take blood samples and mouth swabs and send them down to us at Otago so we can process them in the lab there," Dr Merriman said.
"It would be important, too, for the nurse to talk to patients about their experiences of gout and the things that trigger it," Dr Hollis-Moffatt said.

prevention

There's no sure way to prevent initial or subsequent attacks of gout, but if you already have gout, your doctor may prescribe certain drugs to reduce the risk or lessen the severity of future episodes. These drugs include allopurinol (Zyloprim, Aloprim) and probenecid. Taken daily, they slow the rate at which uric acid is produced and speed its elimination from your body. In general, keeping uric acid levels within a normal range is the long-term key to preventing gout.

Attacks
Acutely, first line treatment should be pain relief. Once the diagnosis has been confirmed, the drugs of choice are indomethacin, other nonsteroidal anti-inflammatory drugs (NSAIDs), or intra-articular glucocorticoids, administered via a joint injection.
Colchicine was previously the drug of choice in acute attacks of gout. It impairs the motility of granulocytes and can prevent the inflammatory phenomena that initiate an attack of gout. Colchicine should be taken within the first 12 hours of the attack and usually relieves the pain within 48 hours.

Its main side-effects (gastrointestinal upset such as diarrhea and nausea) can complicate its use. NSAIDs are the preferred form of analgesia for patients with gout.
Before medical help is available, some over the counter medication can provide temporary relief to the pain and swelling. NSAIDs such as ibuprofen can reduce the pain and inflammation slightly, although aspirin should not be used as it can worsen the condition. Preparation H hemorrhoidal ointment can be applied to the swollen skin to reduce the swelling temporarily. Professional medical care is needed for long term management of gout.
Ice may be applied for 20–30 minutes several times a day.

There are concerns that uric acid crystallization is accelerated by low temperature, but in a 2002 study in the Journal of Rheumatology patients who used ice packs had better relief of pain with no negative side effects. Keeping the affected area elevated above the level of the heart may help as well.

Due to swelling around affected joints for prolonged periods, shedding of skin may occur. This is particularly evident when small toes are affected and may promote fungal infection in the web region if dampness occurs; it is usually treated in a similar fashion to athlete's foot.

How Is It Diagnosed?
Physical exam and medical history.
Blood tests to measure uric acid.
Joint fluid test to check for presence of uric acid crystals.
Treatment Options
Diet
Medications: Colchicine, corticosteroids, NSAIDs, Probenecid, Sulfinpyrazone
Surgery (rare)

watch out for

Signs and Symptoms of Gout

Hyperuricemia
Presence of uric acid crystals in joint fluid
More than one attack of acute arthritis
Arthritis that develops in 1 day, producing a swollen, red, and warm joint

Attack of arthritis in only one joint, usually the toe, ankle, or knee

what research is being done?

Scientists are studying which NSAIDs are the most effective gout treatments, and they are analyzing new compounds to develop safe, effective medicines to lower the level of uric acid in the blood and to treat symptoms. They also are studying the structure of the enzymes that break down purines in the body to achieve a better understanding of the enzyme defects that can cause gout.
Scientists are studying the effect of crystal deposits on cartilage cells for clues to treatment. They also are looking at the role of calcium deposits in pseudogout in the hope of developing new treatments. The role genetics and environmental factors play in hyperuricemia also is being investigated.

for people with gout...

for people with gout...how to stay healthy

To help prevent future attacks, take the medicines your doctor prescribes. Carefully follow instructions about how much medicine to take and when to take it. Acute gout is best treated when symptoms first occur.
Tell your doctor about all the medicines and vitamins you take. He or she can tell you if any of them increase your risk of hyperuricemia.
Plan followup visits with your doctor to evaluate your progress.
Maintain a healthy, balanced diet; avoid foods that are high in purines; and drink plenty of fluids, especially water. Fluids help remove uric acid from the body.
Exercise regularly and maintain a healthy body weight. Lose weight if you are overweight, but do not go on diets designed for quick or extreme loss of weight because they increase uric acid levels in the blood.

Gout

Uric acid is a chemical which is a natural part of the normal breaking down and building up of food and body tissues. The level in the blood can be measured and shows how much there is in the body overall. The condition of raised blood uric acid is called hyperuricaemia. When this is present the uric acid which is normally dissolved in the blood may, from time to time, form microscopic crystals in the joint. These crystals set up the inflammation which is called acute gouty arthritis or acute gout.

It follows that gout may develop in persons whose uric acid is higher than normal. There are many causes of this.

The following are some of the more common causes:
Higher than normal levels of uric acid can be part of the inherited make-up of some families
Obesity
High alcohol intake
High intake of food containing purines (see below)
Some of the drugs used to treat high blood pressure.
Less commonly, longstanding kidney disease may result in high blood levels of uric acid.

Treatments

With proper treatment, most people with gout are able to control their symptoms and live productive lives. Gout can be treated with one or a combination of therapies. The goals of treatment are to ease the pain associated with acute attacks, to prevent future attacks, and to avoid the formation of tophi and kidney stones. Successful treatment can reduce both the discomfort caused by the symptoms of gout and long-term damage of the affected joints. Treatment will help to prevent disability due to gout.
The most common treatments for an acute attack of gout are high doses of nonsteroidal anti-inflammatory drugs (NSAIDs) taken orally (by mouth) or corticosteroids, which are taken orally or injected into the affected joint. NSAIDs reduce the inflammation caused by deposits of uric acid crystals but have no effect on the amount of uric acid in the body. The NSAIDs most commonly prescribed for gout are indomethacin (Indocin*) and naproxen (Anaprox, Naprosyn), which are taken orally every day. Corticosteroids are strong anti-inflammatory hormones. The most commonly prescribed corticosteroid is prednisone. Patients often begin to improve within a few hours of treatment with a corticosteroid, and the attack usually goes away completely within a week or so.

When NSAIDs or corticosteroids do not control symptoms, the doctor may consider using colchicine. This drug is most effective when taken within the first 12 hours of an acute attack. Doctors may ask patients to take oral colchicine as often as every hour until joint symptoms begin to improve or side effects such as nausea, vomiting, abdominal cramps, or diarrhea make it uncomfortable to continue the drug.
For some patients, the doctor may prescribe either NSAIDs or oral colchicine in small daily doses to prevent future attacks. The doctor also may consider prescribing medicine such as allopurinol (Zyloprim) or probenecid (Benemid) to treat hyperuricemia and reduce the frequency of sudden attacks and the development of tophi.

Diagnosis and Prevalence

Who Is Likely To Develop Gout?
Gout occurs in approximately 840 out of every 100,000 people. It is rare in children and young adults. Adult men, particularly those between the ages of 40 and 50, are more likely to develop gout than women, who rarely develop the disorder before menopause. People who have had an organ transplant are more susceptible to gout.

How Is Gout Diagnosed?
Gout may be difficult for doctors to diagnose because the symptoms may be vague, and they often mimic other conditions. Although most people with gout have hyperuricemia at some time during the course of their disease, it may not be present during an acute attack. In addition, having hyperuricemia alone does not mean that a person will get gout. In fact, most people with hyperuricemia do not develop the disease.
To confirm a diagnosis of gout, a doctor may insert a needle into an inflamed joint and draw a sample of synovial fluid, the substance that lubricates a joint. A laboratory technician places some of the fluid on a slide and looks for monosodium urate crystals under a microscope. Their absence, however, does not completely rule out the diagnosis. The doctor also may find it helpful to examine chalky, sodium urate deposits (tophi) around joints to diagnose gout. Gout attacks may mimic joint infections, and a doctor who suspects a joint infection (rather than gout) may check for the presence of bacteria.