Gout is a type of inflammatory arthritis caused by uric acid crystals building up in the joints due to high levels of uric acid in the blood. It most commonly affects the big toe, causing sudden and severe pain. Risk factors include genetics, age, alcohol consumption, diet high in purines, medications, and other medical conditions like diabetes. Diagnosis involves testing uric acid levels in blood and synovial fluid analysis. Treatment focuses on pain relief during flares and lowering uric acid levels long-term through medications and lifestyle changes like diet modification and exercise. Without proper management, gout can progress to chronic arthritis and kidney complications.

1. Catholic University of El Salvador
UNICAES
Subject
English
Theme
Gout
Profesor
Lic. Karla Hernández
Student´s Name
Berganza Mancia, María Estela
Figueroa Hernández, Jacqueline Abigail
Guerra Díaz, Diana Estefania
Mendoza Segura, Erick Steve
Morán Martínez, Jessica Maricela
Section “B”
Date of Delivery
Friday, February 26th, 2016
Santa Ana, Wednesday, January 20th, 2016

2. Introduction
Perhaps the oldest known type of arthritis, gout or gouty arthritis, has a long and
colorful history with some of the earliest descriptions dating back as far as the 5th
century B.C. Historically, gout as been called “the disease of kings” due to its
association with rich foods and alcohol consumption. However, in 2011 we know
that gout does not discriminate based on socioeconomic status but rather it is
directly related to uric acid metabolism. Gout is an inflammatory arthritis that
belongs to a group of arthropathies called the „crystalline arthropathies‟. Gout is
caused by a robust inflammatory response to uric acid crystals which occurs in the
setting of hyperuricemia (high uric acid levels in the blood). Supersaturation of uric
acid can lead to crystal accumulation and deposition in the joints and tissues to
which the immune system reacts. Uric acid tophi (which occur in tophaceou gout)
appear as hard nodules under the skin and can cause considerable destruction
and discomfort.
The association between gout and uric acid has been known since the 19th
century, but it is the important developments in our understanding of the careful
uric acid homeostasis that has led to effective therapy for gout. Today, gout
remains one of the most treatable forms of arthritis.

3. What is gout?
Gout is a rheumatic disease that is especially painful (Figure 1). Caused by uric
acid crystals that build up in the spaces between joints and in the connective
tissues, gout results in stiffness and pain in the joints. A type of inflammatory
arthritis, gout affects more men than women. Women are more likely to suffer from
gout after menopause (Figure 2, 3 and 4).
Symptoms of Gout
Gout is often referred to as feet or toe disease (Figure 5). This is because one of
the most common symptoms of gout is severe pain in the big toe or feet. Apart
from the toe, gout can affect other joints such as the knees and wrist as well. Other
symptoms of gout include:
 Gout first appears as nodules or ‘ tophi’ in the joints of the hands, elbows
and ears.
 A gout attack begins without any warning and can last for a few hours to
over a week. Gout attacks tend to happen in the night or the early hours of
the morning.
 Gout pain in the joints is characterized by a warm or hot feeling along with a
swelling of the affected area.
 During the attack, the joint or area around the joint may become red or even
purple in color.
 As the pain and swelling subside, you are left with peeling and itchy skin
around the affected area.
 Some people may have a fever during the gout attack.
 Gout makes the joints stiff, severely restricting mobility.
 In some cases, there are no visible symptoms of gout. It is these cases that
are more likely to develop into chronic gout, as they tend to remain
untreated.
Causes of Gout
High levels of uric acid in the blood cause gout. When you eat foods rich in purines
such as organ meats, yeast, and oily fish for example, the body breaks down the
purines and produces uric acid. Under normal circumstances, uric acid is flushed
out of the body through the kidneys and by urinating. However, if the body is
producing too much uric acid for the kidneys to process, the levels of uric acid can
rise dramatically, creating a condition called hyperuricemia. This causes needle
like crystals of uric acid builds up around the joints and connective tissues that

4. results in severe inflammation and pain. Other causes of gout and risk factors
include:
 Genetics and Heredity: If your parents or other members in your family
have gout, you are at a higher risk of developing the disease. In such cases,
preventive measures such as changing your diet and reducing your alcohol
consumption can help delay the onset of gout.
 Age and Sex: Gout affects a larger percentage of middle-aged men. Men
have higher levels of uric acid in the body as compared to women and this
may be why this happens. Where women are concerned, gout cases are
found mainly in post-menopausal women.
 Alcohol Abuse: Drinking alcohol especially beer is said to cause gout.
Yeast is considered the culprit out here as a diet heavy with yeast-based
products may also lead to gout. Alcohol also interferes with the removal of
uric acid in the body and therefore leads to high levels causing gout.
 Eating a Diet High in Protein: Having a diet that mainly consists of red
meats, organ meats and oily fish can make you more susceptible to the
development of gout.
 A sedentary Life / Lack of Exercise: Obesity is also linked to the
development of gout. A regular exercise routine can help boost immunity
and prevent obesity.
 Other Medical Conditions: If you suffer from other diseases such as
diabetes or high blood pressure, you may be more predisposed to
developing gout.
 Medication: Certain medications could cause a rise in uric acid levels in the
body. Studies show that diuretic drugs used to treat high blood pressure,
anti-rejection drugs used after transplant surgery and even aspirin can
increase the level of uric acid in the body and cause gout.
 Research indicates that some people may have an enzyme defect that
could interfere with the body’ s natural ability to break down purines and
create uric acid. This could also lead to gout.
 A prolonged exposure to lead can cause gout as well.

5. Exams and Tests
Tests that may be done include:
 Synovial fluid analysis (shows uric acid crystals)
 Uric acid – blood
 Joint x-rays (may be normal)
 Synovial biopsy
 Uric acid -- urine
A uric acid level in the blood over 7 mg/dL is high. But, not everyone with a high
uric acid level has gout.
Treatment
Take medicines for gout as soon as you can if you have a sudden attack.
Take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen,
or indomethacin when symptoms begin. Talk to your health care provider about the
correct dose. You will need stronger doses for a few days.
 Your provider may prescribe strong painkillers such as codeine,
hydrocodone, and oxycodone.
 A prescription medicine called colchicine helps reduce pain, swelling, and
inflammation.
 Corticosteroids (such as prednisone) can also be very effective. Your
provider may inject the inflamed joint with steroids to relieve the pain.
 The pain often goes away within 12 hours of starting treatment. Most of the
time, all pain is gone within 48 hours.
You may need to take daily medicines such as allopurinol (Zyloprim), febuxostat
(Uloric) or probenecid (Benemid) to decrease the uric acid level in your blood.
 You may need these medicines if:

6.  You have several attacks during the same year or your attacks are quite
severe.
 You have damage to joints.
 You have tophi.
 You have kidney disease or uric acid kidney stones.
Diet and lifestyle changes may help prevent gouty attacks:
o Decrease alcohol, especially beer (some wine may be helpful).
o Lose weight.
o Exercise daily.
o Limit your intake of red meat and sugary beverages.
o Choose healthy foods, such as dairy products, vegetables, nuts, legumes,
fruits (less sugary ones), and whole grains.
o Drink coffee and take vitamin C supplements (may help some people).
Outlook (Prognosis)
Proper treatment of acute attacks and lowering uric acid to a level less than 6
mg/dL allows people to live a normal life. However, the acute form of the disease
may progress to chronic gout if not treated.
Possible Complications
Complications may include:
 Chronic gouty arthritis
 Kidney stones
 Deposits in the kidneys, leading to chronic kidney failure
Diet for Gout
One of the most effective ways to prevent gout from developing is by changing
your diet and eating habits. Some suggestions for diet for gout include:
Including cherries in your diet. Cherries both sweet and sour cherries are full
of antioxidants that can relieve inflammation and pain symptomatic of a gout
attack. Eat a minimum of 20 fresh cherries a day for the best results. Do this
preferably as soon as you get up in the morning.

7. Eating apples can neutralize the levels of uric acid in the body. The malic
acid found in apples provides relief from gout pain. Eat an apple after every
meal for this to be effective.
Bananas are high in potassium required to treat gout. Potassium helps
transform crystals of uric acid into liquid form making them easier to be
flushed out of the body. A banana diet for four days can works wonders in
treating symptoms of a gout attack.
Other gout friendly foods include:
 Green leafy vegetables such as cabbage, kale, and parsley
 Pineapple
 Foods rich in vitamin C such as tomatoes, red bell peppers, oranges and
red cabbage
 Low-fat dairy products
 Foods high in essential fatty acids such as salmon
 Apart from including these additions to your diet, avoid the following foods to
prevent gout from recurring:
 Meats
 Organ meats such as brain, liver, and kidney
 Oily fish such as herrings, mackerel, scallops, and anchovies
 Refined sugar
 Caffeine
 Tea
 Eggs
 White flour
 Fried and oily foods
 Processed foods
 Canned foods
 Carbonated beverages
 Alcohol especially beer
 Yeast
 Meat extracts

8. Annexes
Figure 1: Gout
Figure 2: Gout in food
Figure 3: Gout in elbows

9. Figure 4: Gout in Knee
Figure 5: Symptoms of Gout
Treatment of gout

10. Conclusion
Lifestyle and dietary recommendations for gout patients should consider other
health benefits and risk, since gout is often associated with major chronic disorders
such as the metabolic syndrome and an increased risk for CVD and mortality.
Weight reduction with daily exercise and limiting intake of red meat and sugary
beverages would help reduce uric acid levels, the risk of gout, insulin resistance,
and comorbidities.
Heavy drinking should be avoided, whereas moderate drinking, sweet fruits, and
seafood intake, particularly oily fish, should be tailored to the individual,
considering their anticipated health benefits against CVD. Alternatively, the use of
plant-derived omega-3 fatty acids or supplements of EPA and DHA could be
considered instead of fish consumption. Vegetable and dairy protein, nuts,
legumes, fruits (less sugary ones), and whole grains are healthy choices against
various comorbidities of gout and would not increase the risk of gout, and may
even help lower the risk of gout by reducing insulin resistance. Coffee can be
allowed, if it is already being consumed, and vitamin C supplementation can be
considered, as both can lower serum urate levels, as well as the risk of gout and
some of its comorbidities.

11. Bibliography
Gout, MedinePlus. https://www.nlm.nih.gov/medlineplus/ency/article/000422.htm
Gout, Nationalinstitute of artrithis an Musculoeskeleta and Skin Diseases.
http://www.niams.nih.gov/Health_Info/Gout/gout_ff.asp
Gout, TuOtroMédico. http://www.tuotromedico.com/temas/gota.htm
Gout, GeoSalud. http://www.geosalud.com/artritis/gota2.htm