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Don't take gout sitting down.

A study published in the July issue of the American Journal of Medicine reveals that the incidence of gout in the U.S. has risen over the last 20 years--it now affects 8.3 million Americans, or 4 percent of the population. While men are particularly vulnerable to gout, women become increasingly susceptible after menopause. The study also revealed an association with chronic health issues such as hypertension, kidney disease, diabetes, and obesity.

Gout is a painful form of arthritis that occurs when uric acid accumulates in the body, causing crystal-like deposits to form in the joints. It presents with the sudden onset of intense pain, swelling, and tenderness in a joint. In younger patients, it commonly starts in one joint (usually the big toe), but in older adults gout may present in the knee, or in multiple small joints of the hand. The pain may develop during the night and has been described as throbbing, crushing, and/ or excruciating. The affected joint will appear red and may be warm and tender to the touch. 'Acute gout eventually subsides on its own, but the condition can be very painful," says Leslie Kerr, MD, a rheumatologist at Mount Sinai.

You may suffer from one attack of gout and never experience it again, but more than half of the people who experience gout will suffer from more than one attack, and subsequent attacks often take longer to subside. It also is possible to develop what is called chronic tophaceous gout, which can cause joint damage and loss of motion.

Who gets gout? 'Almost all people with gout have high uric acid levels--known as hyperuricemia--however, only about a third of those with hyperuricemia develop gout," says Dr. Kerr. Those that do tend to consume more alcohol, meat and seafood, use certain diuretics, and be obese. Hyperuricemia without gout symptoms doesn't require treatment, but gout does."

"Gout can be associated with other chronic conditions due, in part, to their effect on kidney function," says Dr. Kerr." "High uric acid levels can be caused by a variety of conditions, including diabetes and kidney disease. Additionally, obesity is a risk factor for both gout and many of the other conditions mentioned in the study." Many patients with these comorbid conditions may be taking diuretics or daily aspirin, which can inhibit the excretion of uric acid.

Treatment and prevention Acute gout is treatable, and there also are ways to reduce the risk that it will recur. "Treatment of flare-ups generally includes high-dose nonsteroidal anti-inflammatory (NSAID) drugs," Dr. Kerr says. Older adults are at increased risk of cardiac, renal and gastrointestinal adverse events from these drugs, so speak with your doctor before taking them--he or she may recommend other or additional medications to decrease your risks

Corticosteroids and colchicine are also common treatment options for acute gout. 'An injection of corticosteroids directly into the affected joint can help, although this is not feasible for small joints or attacks involving several joints," advises Dr. Kerr. In these cases, treatment with 30 to 60 mg of prednisone is also an option." Colchicine in very low doses is also often prescribed to quell an acute attack.

Diet, alcohol reduction, low-dose colchicine, and medications to decrease uric acid are used to prevent recurrent gout. For many years, a diet that was "purine-restricted" was recommended, since uric acid is derived from purines (which occur naturally in the body, and in many high-protein foods). However there are now potent medications that decrease uric acid levels. The risk of another attack of gout can be further decreased by losing weight through caloric restriction, and increased protein intake from low-fat dairy products, not red meat and fish, which are high in purines. Alcohol intake should be two or fewer drinks per day for men and one for women. Beer is associated with a greater risk of gout than wine.
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Title Annotation:WELL BEING
Publication:Focus on Healthy Aging
Date:Oct 1, 2012
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