Gout

Gout is a type of arthritis (inflammation of the joints) that mostly arises in men age 40 years and older. Women can also develop gout, although it is more likely to occur after menopause. Gout is caused by a buildup of needlelike uric acid crystals in the joints. Uric acid is a waste product in your body that comes from two sources:

1. Normal cell metabolism
2. Digestion of the food you eat

Under normal conditions, most uric acid is passed through the kidneys and is eventually excreted in the urine. There is a small amount of uric acid in your blood at all times, which does not cause problems. However, in patients with gout, the amount of uric acid in the blood is higher than normal, either because their body produces too much uric acid or because their kidneys are unable remove uric acid from the blood. The excess amount of uric acid in individuals with gout is stored in the joints and over a period of time may result in crystal formation. The uric acid crystals deposited in the joints are responsible for the excruciating pain of gout.

There are two types of gout, primary and secondary, depending on the cause of high uric acid in the blood.

Primary Gout: Primary gout is the most common. In primary gout the cause of excess uric acid is usually not known. Most scientists believe that primary gout is caused by genetics, which means that patients probably inherited this condition from someone in their family. The basic defect is either an impaired clearance of uric acid by the kidneys (also termed "underexcreter"), an increase in production of uric acid (termed "overproducer"), or a combination of both defects.

Secondary Gout: In secondary gout, the cause of excess uric acid is usually known. Most commonly, secondary gout is caused by certain medications or health conditions.

Medications that may cause secondary gout include:

• Diuretics ("water pills"), such as chlorothiazide (Diuril), chlorthalidone (Hygroton), hydrochlorothiazide (Esidrix, HCTZ, HydroDIURIL, Oretic), metolazone (Mykrox, Zaroxolyn), bumetanide (Bumex, Edecrin), ethacrynic acid, furosemide (Lasix), torsemide (Demadex)
• Pyrazinamide (PZA)
• Cyclosporine (Sandimmune, Neoral)
• Aspirin
• Nicotinic acid (Niacin)
• Levodopa

Health conditions that may cause secondary gout include:

• Alcoholism
• Leukemia
• Lymphoma
• Lung cancer
• Smoking
• Psoriasis
• Obesity
• Kidney dysfunction
• Congestive heart failure
• Starvation
• Anemia
• Untreated high blood pressure
• Diabetes
• Severe illness or injury
• Immobility due to bed rest
• Down's syndrome
• Thyroid disorders