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NEW LOOK AT AN OLD-FASHIONED DISEASE

It may sound like an old-fashioned disease more likely to afflict kings and Shakespearean characters than people today. But gout, a form of arthritis, is very much with us.

Gout is caused by uric acid that crystallizes and is then deposited in a joint. It's normal to have some uric acid in the body, because it's a common byproduct of cell breakdown. In most people, the uric acid is dissolved in blood and goes through the kidneys into the urine. In people with gout, this elimination doesn't occur completely and uric acid crystals develop.

The body may produce too much uric acid on its own, or dietary intake may include too many foods high in purines -- such as liver or beans -- that are easily metabolized into uric acid. In some cases, the body is just susceptible to the formation of uric acid crystals, though the level of uric acid is normal or even low.

Who gets gout? It mainly strikes middle-aged men, but occasionally occurs in younger men as well. Gout also afflicts middle-aged women, but it is much more rare.

The joint pain and swelling of gout usually happen suddenly, without warning. In many cases, pain is felt in one or more joints, often at night. The joint becomes inflamed and the pain is often severe. The joint can become red and extremely hot. Anything that touches the skin increases the pain.

When a gout attack occurs in several joints at once, the individual usually feels quite ill, as well as experiencing pain in each afflicted joint. Gout frequently strikes the joint at the base of the big toe but can also affect the small joints of the hands, knees, ankles, wrists or elbows.

The crystal deposits form in these peripheral areas mainly because they are farther from the warm, central core of the body. The uric acid crystallizes at cooler temperatures, which is why the hips, shoulders and spine are rarely affected.

The first few gout attacks usually affect only one joint and last a few days. Symptoms slowly disappear, the joint goes back to normal, and there is no sign of a problem -- until the next attack.

It is important to seek medical treatment as soon as possible after the first attack. Untreated attacks may last longer, occur more often and affect other joints. The joints also may become permanently damaged or deformed.

Gout is not life-threatening, but it is important to seek medical treatment if you are already taking heart or blood pressure medication.

Because each case of gout is different, doctors offer medical treatment based on the severity of the problem. For example, tophaceous gout, a more severe version, occurs when the uric acid not only crystallizes but also hardens to form lumps of urate crystals known as tophi. These often need to be surgically removed.

In some cases, doctors may recommend relieving pain by controlling inflammation with non-steroidal anti-inflammatory drugs such as ibuprofen and indomethacin. Physicians will often aspirate the joint to determine exactly what kind of crystallization has occurred, because there are many conditions that mimic gout and require different treatments. Treatment also depends on whether the gout attacks are frequent or rare (once a year).

People with kidney disease are often predisposed to gout. To prevent recurrence, it is a good idea to drink plenty of fluids, avoid alcohol and eat less protein-rich foods.

Some people who have gout are overweight. When they lose weight, they reduce their risk of suffering from gout. The good news is that gout can be effectively treated and controlled.

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