Gout

Gout, or uric acid arthritis, is a metabolic disease of the bones and joints, but also of the whole body, and it is an independent cardiovascular risk factor. Podagra – the old name for the form that primarily affects the base joint of the big toe (the metatarsophalangeal joint) – is usually the first presentation of the disease.

The disease can also affect the ankle and knee, as well as the elbow and hands, and in untreated cases deposits of urate (uric acid) known as tophi form, which can sometimes break through the skin like chalk.

An attack comes on suddenly, usually out of the blue, but it can be provoked by cold, heat, fasting and thirst. The joint is red, extremely painful and swollen, and after a few days the skin may peel; the attack itself lasts several days (usually 3–7), and the disease gradually subsides with or without medication. Untreated, the disease leads to frequent attacks and the formation of urinary stones, as well as an increased risk of myocardial infarction and other vascular events.

Older-generation drugs such as allopurinol and newer ones such as febuxostat have proved effective and relatively safe under close supervision by a specialist, with regular measurement of serum urate (uric acid) levels. Corticosteroids are an excellent solution in the acute phase but are not optimal in the long term; some biological drugs such as anakinra (an IL-1 blocker), uricase enzymes, or older drugs such as colchicine, probenecid and benzbromarone remain an accepted treatment in some countries. Specific changes in the joints and bones can also be seen on imaging.

Key features:
– gout is the most common inflammatory arthritis in men over 40
– it does not occur in women before the menopause
– hyperuricaemia (a raised level of uric acid in the blood) is associated with obesity and metabolic syndrome
– dietary measures and lifestyle changes are essential for controlling the disease and preventing attacks
– a rheumatologist always considers gout even when the uric acid level is normal, which happens in almost a third of cases
– coexisting diseases (comorbidities) and impaired liver and kidney function must also be managed to keep the uric acid level as low as possible