Gout is a disease that causes the sudden onset of intense pain and swelling in the joints, which also may be warm and red. Attacks frequently occur at night and can be triggered by stressful events, alcohol or drugs, or the presence of another illness.

Before an attack, needle-like crystals of uric acid build up in connective tissue, in the joint space between two bones, or in both.

Uric acid is a substance that results from the breakdown of purines, which are part of all human tissue and are found in many foods. Early attacks usually subside within 3 to 10 days, even without treatment, and the next attack may not occur for months or even years.

Adult men, particularly those between the ages of 40 and 50, are more likely to develop gout than women, who rarely develop the disease before menstruation ends.

Sometime during the course of the disease, many patients will develop gout in the big toe. Gout frequently affects joints in the lower part of the body such as the ankles, heels, knees, or toes.

Researchers have discovered some of the risk factors for gout. Some people with gout have a family history of the disease. In addition to inherited traits, diet, weight, and alcohol play a role in the development of gout. The disease is more common in men.

Most people with gout have too much uric acid in their blood, a condition called hyperuricemia. The extra uric acid moves from the blood to the joints, which may trigger the inflammation seen in gout. 
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Different types of arthritis have different symptoms. In general, people with most forms of arthritis have pain and stiffness in their joints. Gout typically attacks one joint at a time, and the attacks usually begin at night.

Hyperuricemia -- high levels of uric acid in the body -- contributes to arthritis that develops in one day, producing a swollen, red, and painful joint. Gout attacks usually begin at night.

Gout normally attacks joints in the lower part of the body, such as the knee, ankle or big toe. For many people the joints in the big toe are the first to be attacked. In fact, sometime during the course of the disease, many people will develop gout in the big toe.

To confirm a diagnosis of gout, the doctor inserts a needle into the inflamed joint and draws a sample of synovial fluid, the substance that lubricates a joint. A laboratory technician places some of the fluid on a slide and looks for monosodium urate crystals under a microscope. If crystals are found in the joint fluid, the person usually has gout.

With proper treatment, most people with gout are able to control their symptoms and live productive lives.

The goals for treatment are to ease the pain that comes from sudden attacks, prevent future attacks, stop uric acid buildup in the tissues and joint space between two bones, and prevent kidney stones from forming.

The most common treatments for an attack of gout are high doses of non-steroidal anti-inflammatory drugs, or NSAIDs, which are taken by mouth, or corticosteroids, which are taken by mouth or injected into the affected joint. Patients often begin to improve within a few hours of treatment. The attack usually goes away completely within a week or so.

Since NSAIDs are now available over the counter, it is important to check with your doctor concerning the safety of using these drugs and to verify the proper dosage.

When NSAIDs or corticosteroids fail to control pain and swelling, the doctor may use another drug, colchicine. This drug is most effective when taken within the first 12 hours of an acute attack.

Scientists are studying which NSAIDs are the best ones to treat gout. They are analyzing new compounds to develop safe, effective medicines. Current research is also focusing on the structure of certain enzymes to gain a better understanding of defects that can cause gout.

Scientists are studying the effect of crystal deposits on cartilage cells for clues to treatment. They are also looking at the role of calcium deposits and how they contribute to the development of gout in the hope of finding new treatments.

In addition, researchers are investigating how genetics and the environment may influence the level of uric acid in the blood. 
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