Sunday, January 15, 2006

gout

Gout is a metabolic disorder characterized by recurrent attacks of arthritis due to deposits of uric acid in the joints and other tissues. The big toe is the most common site of initial involvement in over 50 percent of cases. Later, other joints that are frequently affected include the finger joints, wrists, and elbows.
The great majority of patients have primary gout, which appears to be due to an inherited disorder of metabolism. Secondary gout is due to overproduction of uric acid or a retention of uric acid. In primary gout, over 90 percent of the patients are male with the peak period of onset during the fifth decade. Women are affected after menopause. In secondary gout, the average age of onset and the frequency with which women are affected are both greater than in primary gout.
Onset of acute gout is very rapid with maximal pain and swelling usually reached in several hours. The affected joint is exquisitely painful and tender and the patient may suffer chills and low-grade fever. After recovery from the initial attack, the patient can remain free of symptoms for months or years. However, subsequent attacks tend to occur with greater severity and at more frequent intervals.
Anti-inflammatory agents are prescribed for controlling the symptoms of gout. Lowering the level of body uric acid with the use of uriosuric agents is necessary to prevent urate deposition. These agents should be avoided during acute attacks of gout because they exaggerate the symptoms. If the joint is severely destroyed surgical joint replacement may need to be considered.
Reichel, W. M. Clinical Aspects of Aging. Baltimore: The Williams & Wilkins Co., 1979.

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