Gout, called the disease of kings and the king of diseases, has an ancient history. Well known to both the Greeks and the Romans, it is characterized by acute, very painful attacks of arthritis. In 1683 Dr. Thomas Sydenham described a typical first attack in this way:
The victim goes to bed and sleeps in good health. About two o'clock in the morning, he is awakened by pain in the great toe; more rarely in the heel, ankle or instep. The pain is like that of a dislocation, and yet the parts feel as if cold water were poured over them. Then follows chills and shivers and a little fever. The pain, which was at first moderate, becomes more intense. With its intensity the chills and shivers increase. After a time this comes to its full height. Now it is a violent stretching and tearing of the ligaments— now it is a gnawing pain and now a pressure and tightness. So exquisite and lively meanwhile is the feeling of the part affected, that it cannot bear the weight of bedclothes nor the jar of person walking in the room. The night is passed in torture, sleeplessness, turning of the part affected, and perpetual change of posture.
The duration of an attack of gout varies from a few days to several weeks. When it subsides, the joint returns to its normal state.
The second attack may not occur for one or two years. Subsequently the interval between attacks becomes shorter and shorter, and remission between attacks eventually becomes incomplete; multiple joints become involved, and inflammation may occur in bursae, the small cushions of fluid that facilitate the movement of one structure, such as a tendon, over another.
Gout is a characterized by abnormally high levels of uric acid, a byproduct of metabolism, in the blood and tissues. Crystals of uric acid are deposited in the joints, where they cause arthritis. Crystals also may be deposited in the kidneys, where they can lead to kidney damage or to the formation of uric acid kidney stones.
In some patients without kidney disease, high uric acid levels are promoted by a diet rich in purines, which are found in anchovies, nuts, and organ foods such as liver and sweetbreads. More commonly, the body's own production of uric acid is too high, regardless of diet. Factors that increase the likelihood of gout include obesity or sudden weight gain, alcohol intake (especially binge drinking), high blood pressure, family history of gout, trauma or major surgery, and certain types of cancer or cancer treatment. Some 90 percent of patients with gout are over 40 years old, and most are males. Gout is rare in younger women.
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