61. Arthritis Research Campaign | Gout gout has been known since before the days of Christ. As far back as the What is gout and what causes it? The old adage that simply http://www.arc.org.uk/about_arth/booklets/6015/6015.htm

scotland + n. ireland north wales + midlands east + southeast ... south + southwest Introduction Gout has been known for more than 2000 years. It can affect men of any age. It is less common in women and then only occurs after the menopause. Luckily, gout is probably the rheumatic disease for which there is the most satisfactory treatment. What is gout and what causes it? People get gout because there is something wrong with the chemical processes of their body. Urate (which we all have in our blood) can build up and form crystals in the joints and cause them to feel intensely painful. This defect is usually inherited from a parent or grandparent. Gout runs in families. The joints are not the only part of the body to be affected. Crystals may appear under the skin, including sometimes on the ear. They look like little white pimples and are called 'tophi'. What is the role of urate?

62. Gout And Hyperuricemia - February 15, 1999 - American Academy Of Family Physicia February 15, 1999 AFP. gout and Hyperuricemia. 21. TABLE 3 Drugs Used in the Management of Acute gout. Drug, Dosage, Side effects/comments. http://www.aafp.org/afp/990215ap/925.html

Advanced Search Gout and Hyperuricemia MARK D. HARRIS, M.D., Wilford Hall, USAF Medical Center, San Antonio, Texas LORI B. SIEGEL, M.D., Finch University of Health Sciences, Chicago Medical School, Chicago, Illinois JEFFREY A. ALLOWAY, M.D., Wilford Hall, USAF Medical Center, San Antonio, Texas C Although hyperuricemia predisposes patients to gout and nephrolithiasis, it does not need to be treated in the asymptomatic patient. However, efforts should be made to modify or correct underlying causes. Epidemiology Gouty arthritis is the most common form of inflammatory joint disease in men older than 40 years. The National Health Survey (1983 to 1985) determined the prevalence rate of self-reported gout to be 13.6 cases per 1,000 men and 6.4 cases per 1,000 women. These numbers reflect an approximate threefold increase in the prevalence of gout since 1969. In contrast, cases of physician-diagnosed gout suggest a consistently lower prevalence rate5.0 to 6.6 cases per 1,000 men and 1.0 to 3.0 cases per 1,000 women. TABLE 1 Acquired Causes of Hyperuricemia Increased urate production Cause Nutritional Excess purine, ethanol, fructose consumption

63. Diagnosis And Management Of Gout - April 1, 1999 - American Academy Of Family Ph Diagnosis and Management of gout. JOEL R. PITTMAN, PHARM. TABLE 2 Treatment of gout with Selected Nonsteroidal Antiinflammatory Drugs*. Medication, Dosage, http://www.aafp.org/afp/990401ap/1799.html

Advanced Search Diagnosis and Management of Gout JOEL R. PITTMAN, PHARM. D., and MICHAEL H. BROSS, M.D. University of Mississippi Medical Center Jackson, Mississippi A patient information handout on gout, written by the authors of this article, is provided on page 1810. G Pathogenesis Hyperuricemia is a risk factor for gout, but some patients with normal serum uric acid levels develop acute gouty arthritis. Uric acid, the end product of purine metabolism, is a waste product that has no physiologic role. Humans lack uricase, an enzyme that breaks down uric acid into a more water-soluble product (allantoin), thus preventing uric acid accumulation. Increased serum uric acid concentration is a result of either overproduction or underexcretion of uric acid. In 90 percent of patients, gout is caused by the underexcretion of uric acid. Although hyperuricemia is a risk factor for the development of gout, the exact relationship between hyperuricemia and acute gout is unclear. Acute gouty arthritis can occur in the presence of normal serum uric acid concentrations. Conversely, many persons with hyperuricemia never experience an attack of gouty arthritis. Hyperuricemia can have many causes. Serum uric acid levels become elevated in any disorder that results in the proliferation of cells or the excessive turnover of nucleoproteins. Hyperuricemia can also occur with decreased renal function and in genetic disorders that increase the production or limit the excretion of uric acid

64. MayoClinic.com - Gout The basics about recognizing, treating and preventing this condition from the Mayo Clinic. http://www.mayoclinic.com/home?id=5.1.1.7.6

65. EMedicine - Gout And Pseudogout : Article By Joseph Kaplan, MD, FACEP gout and Pseudogout gout and pseudogout are the 2 most common crystal-induced arthropathies. They are debilitating illnesses in http://www.emedicine.com/EMERG/topic221.htm

(advertisement) Home Specialties Resource Centers CME ... Patient Education Articles Images CME Patient Education Advanced Search Consumer Health Link to this site Back to: eMedicine Specialties Emergency Medicine Rheumatology Gout and Pseudogout Last Updated: May 4, 2004 Rate this Article Email to a Colleague Synonyms and related keywords: calcium pyrophosphate disease, CPPD, peripheral arthritis, sodium urate crystals, monosodium urate monohydrate crystals, MSU crystals, calcium pyrophosphate crystals, CPP crystals, podagra, hyperuricemia, primary gout, secondary gout, intermediate gout, late-phase gout, pseudogout, tophi, gouty nephropathy, gouty arthritis, first metatarsophalangeal joint pain, uric acid, increased serum uric acid, arthritis nodosa, arthritis uratica, foot pain, edema of the foot AUTHOR INFORMATION Section 1 of 10 Author Information Introduction Clinical Differentials ... Bibliography Author: Joseph Kaplan, MD, FACEP , Chief, Assistant Professor of Emergency Medicine, Department of Operational and Emergency Medicine, Martin Army Community Hospital Joseph Kaplan, MD, FACEP, is a member of the following medical societies:

66. Gout Extensive information for patients, including symptoms, treatments, nutritional considerations, recovery, questions for your doctor, FAQs, emergencies and prevention. http://www.seekwellness.com/gout/index.htm

home wellness pelvic health other conditions ... contact us // syntax: swSlideMenu(id, dir, left, top, width, height) new swSlideMenu('menu1', 'down', 230, 91, 180, 350); new swSlideMenu('menu2', 'down', 295, 91, 180, 350); new swSlideMenu('menu3', 'down', 381, 91, 180, 350); new swSlideMenu('menu4', 'down', 487, 91, 180, 350); home other conditions gout center addison's disease arthritis eating disorders gout center ... resources gout Articles in this category: What Is It? Signs and Symptoms Diagnosis Treatments ... Wellness Perspective Last updated: December 2001 send us an e-mail message Search our site Join our mailing list e-commerce items view cart contents go shopping! featured book: Go to the bookstore news and future events featured links andropause center men's sexuality center incontinence center wellness store feedback privacy about us your partner in the quest for wellness A WPL Property . 26 South Main Street, PMB #162 . Concord, NH 03301 . Phone: 603 226-8760 fitness health consumerism mental health nutrition ... wellness store

67. EMedicine - Gout : Article By Christopher D Smelser, DO gout gout is defined as a peripheral arthritis resulting from the deposition of sodium urate crystals in one or more joints. A http://www.emedicine.com/radio/topic313.htm

(advertisement) Home Specialties CME PDA ... Patient Education Articles Images CME Patient Education Advanced Search Link to this site Back to: eMedicine Specialties Radiology Musculoskeletal Gout Last Updated: May 31, 2002 Rate this Article Email to a Colleague Synonyms and related keywords: peripheral arthritis, sodium urate crystals, podagra, hyperuricemia, primary gout, secondary gout, intermediate gout, late-phase gout, pseudogout, tophi, gouty nephropathy, gouty arthritis, first metatarsophalangeal joint pain AUTHOR INFORMATION Section 1 of 10 Author Information Introduction Differentials X-ray ... Bibliography Author: Christopher D Smelser, DO , Staff Physician, Department of Radiology, William Beaumont Army Medical Center Coauthor(s): Robert D Stoffey, DO , Director of Women's Imaging, Chief of Mammography Section, Department of Radiology, William Beaumont Army Medical Center; Amilcare Gentili, MD , Consulting Staff, Clinical Professor of Radiology, Department of Radiology, University of California at San Diego -Thornton Hospital Christopher D Smelser, DO, is a member of the following medical societies:

68. EMedicine Health - Gout Overview Consumer health resource center providing an overview of gout and its causes, symptoms, and treatment. http://www.gout.e-medicinehealth.com

Search June 2, 2004 Registration Healthcare Professionals High cholesterol can affect children. Is your child at risk? About 1 million people in the United States have Crohn disease. What are treatment options? Is there a connection between IBD and Crohn Disease? About one third of those with diabetes do not know they have it. Are you one? Two million or more Americans have schizophrenia. Is someone you love affected? One third of those with asthma are children. What are the symptoms and triggers? Asthma Cholesterol Crohn Disease Diabetes ... Mental Health You are in: Kidneys and Urinary System Gout Overview Gout is a condition in which the body has a problem in the handling of uric acid. Plead with gout either produce too much uric acid or more commonly have a problem in removing it. There are a number of possible consequences of this build up of uric acid in the body, including acute and chronic gouty arthritis, kidney stones, and deposits of uric acid in subcutaneous and other tissues (tophi). Gout may occur alone (primary gout) or may be associated with certain medical conditions or medications (secondary gout). Gouty arthritis should be considered in people who have a sudden onset of a hot, red, swollen joint. It is diagnosed by finding uric acid (monosodium urate) crystals in the joint fluid. These crystals can accumulate over the years in the joint and trigger repeated bouts of inflammation. If left untreated, the accumulated crystals can damage the joint and lead to chronic arthritis. Fortunately, there are effective medications to treat gout.

69. Gout - Complete Information From EPodiatry gout. Information for health. Symptoms of gout gout usually only affects one joint at a time (sometimes two) most often the feet and ankles. http://www.epodiatry.com/gout.htm

Sign up for our newsletter Your email address will only be used for distribution of the ePodiatry newsletter and no other purpose Web site designers WebGenius Gout Information for health professionals on gout Gout is one of the most common forms of arthritis or inflammation of a joint. It most commonly affects the big toe joint (first metatarsophalangeal joint), but can affect any joint. Gout usually starts as an acute attack that often comes on overnight. Within 12-24 hours there is usually severe pain and swelling in the joint. Screw up the vise as tightly as possible - you have rheumatism; give it another turn, and it is gout Symptoms of Gout: Gout usually only affects one joint at a time (sometimes two) - most often the feet and ankles. The joint at the base of the big toe is the most common site. If there is no treatment the gout attack usually subsides in a week or so. After the first attack there may be intervals of many months or even years before there are other attacks. Over time these attacks tend to become more frequent and more severe and eventually may involve other and more joints. Eventually, without treatment, a state of chronic or continuous joint symptoms may develop with progressive joint damage.

70. Discovery Health Gout gout is a form of arthritis, or joint inflammation, that is caused by increased uric acid in the bloodstream. search, gout. By James Broomfield, MD. http://health.discovery.com/diseasesandcond/encyclopedia/663.html

71. Gout Haters.Com, Gout's Worst Nightmare GOUT GOUT GOUT Forums and information for people that have been diagnosed with this disease. http://www.gouthaters.com

Gout Gout Gout Gout Purine Gout Purine gout attack medication diet low purine low purine recipe forum information Gout Gout Gout Gout Purine Gout Purine gout attack medication diet low purine low purine recipe forum information Register Gout Haters Forums General Discussion Gout Attack Problems and Solutions Gout Long Term Goals and Solutions Gout Medication Discussion Low Purine Diets and Foods Discussion Herb Discussion User Rendered Information and Links ... Exercise Information Welcome To Gout Haters.Com. This site is set up to assist those that may have been diagnosed with Gout. The Reason for this site is to share information, recipes and any information that may be relevant to the cause or prevention of this disorder. Gout Links Gout Information Gout Tutorials Gout Medications ... Email Us Welcome to Gout Haters! This site is dedicated to everyone having or everyone that has to do with someone with Gout. Please use this site to help yourself or loved one with gout to overcome and conquer this fierce battle. Click on the forum topics on the left to enter any portion of the forum.

72. THE MERCK MANUAL, Sec. 5, Ch. 55, Crystal-Induced Conditions gout. The greater the degree and duration of hyperuricemia, the greater the chance of crystal deposition and of acute attacks of gout. http://www.merck.com/mrkshared/mmanual/section5/chapter55/55a.jsp

73. Gout gout. March 2002. WHAT IS gout? The Processes in the Body Leading to Hyperuricemia and gout. gout is an arthritic condition (inflammation http://www.reutershealth.com/wellconnected/doc93.html

Gout March 2002 WHAT IS GOUT? The Processes in the Body Leading to Hyperuricemia and Gout Gout is an arthritic condition (inflammation of the joints) that mostly affects men age 40 and older. It is nearly always associated with chronic hyperuricemia , a long-lasting abnormally high concentration of uric acid in the blood. Metabolism of Purines. The process leading to hyperuricemia and gout begins with the metabolism of purines , which are nitrogen-containing compounds that are important for energy. Purines can be divided into two types: Endogenous. Endogenous purines are manufactured within human cells. Exogenous. Endogenous purines are obtained from foods. All mammals except humans possess an enzyme called uricase that breaks purines down into a very soluble product called allantoin . Without uricase, purine ultimately breaks down into uric acid , which can build up in body tissues if it is not adequately eliminated in urine. Uric Acid and Hyperuricemia. Uric acid is produced in the liver and enters the bloodstream. The path leading to high concentrations of uric acid and gout is the following: Most uric acid eventually passes through the kidneys and is excreted in the urine. The rest is disposed of in the intestines, where it is processed and broken down by bacteria.

74. THE MERCK MANUAL, Sec. 5, Ch. 55, Crystal-Induced Conditions Overview of the signs, symptoms, diagnosis, prognosis and treatment of gout. http://www.merck.com/pubs/mmanual/section5/chapter55/55a.htm

This Publication Is Searchable The Merck Manual of Diagnosis and Therapy Section 5. Musculoskeletal And Connective Tissue Disorders Chapter 55. Crystal-Induced Conditions Topics Gout Idiopathic Hyperuricemia Calcium Pyrophosphate Dihydrate Crystal Deposition Disease Basic Calcium Phosphate And Other Crystal Disorders Gout A recurrent acute or chronic arthritis of peripheral joints that results from deposition in and about the joints and tendons of monosodium urate crystals from supersaturated hyperuricemic body fluids. Pathophysiology Tophi are MSU crystal aggregates. They are large enough to first be seen on x-rays of the joints as punched-out lesions and later seen or felt as subcutaneous nodules. At the acid pH of urine, uric acid itself is precipitated readily as small platelike crystals that may aggregate to form gravel or stones, which may cause obstructive uropathy. Sustained hyperuricemia is usually caused by decreased renal clearance of urate, especially in patients receiving chronic diuretic therapy and in patients with primary renal diseases that decrease GFR. The greater the degree and duration of hyperuricemia, the greater the chance of crystal deposition and of acute attacks of gout. However, many hyperuricemic persons never develop gout. The serum urate level reflects the size of the extracellular miscible urate pool, which normally turns over once every 24 h; 1/3 of the urate is excreted in the feces, and 2/3 in the urine. Normal 24-h urinary uric acid excretion is 300 to 600 mg after 3 days on a low-purine diet or about 600 to 900 mg on a regular diet. Therefore, food intake accounts for about 450 mg of uric acid daily. Hyperuricemia and gout are common complications in patients receiving cyclosporine for organ transplants. Mean urate levels in premenopausal women are about 1 mg/dL (0.6 mmol/L) lower than those in men, but after menopause the levels approach those of men.

75. Gout -- Related Information Other Places To Get Help. Related Information. References. Credits. gout Related Information Rheumatoid Arthritis. previous section, ^back to top, next section . To. http://my.webmd.com/hw/arthritis/hw69011-RelInfo.asp

var guid_source = ""; var guid_source_id = ""; //unused var encodedurl = ""; WebMD Today Home WebMD News Center Member Services WebMD University My WebMD Find a Physician Medical Info Check Symptoms Medical Library Quizzes, Calculators Clinical Trials ... Women, Men, Lifestyle Who We Are About WebMD Site Map You are in Choose a Topic All Conditions ADD/ADHD Allergies Alzheimer's Arthritis Asthma Back Pain Breast Cancer Cancer Dental Depression Diabetes Eye Health Heart Disease Hepatitis HIV/AIDS Hypertension Men's Conditions Mental Health Migraines/Headaches Multiple Sclerosis Osteoporosis Parkinson's Sexual Conditions Stroke Weight Control Women's Conditions Health Topics Symptoms Medical Tests Medications ... Credits Gout Related Information Rheumatoid Arthritis < previous section back to top next section > ... To Search the Help Last updated: July 11, 2002 Print-Friendly Version This information is not intended to replace the advice of a doctor. Medscape for Physicians Medscape for Healthcare Professionals Corporate Contact Us ... WebMD

76. Beer, Spirits Increase Gout Risk As few as two to four beers a week may increase the risk of gout by 25%, researchers say. Beer, Spirits Increase gout Risk. But Wine May Be OK, Researcher Says. http://my.webmd.com/content/article/85/98708.htm

WebMD Today Home WebMD News Center Member Services WebMD University My WebMD Find a Physician Medical Info Check Symptoms Medical Library Quizzes, Calculators Clinical Trials ... Women, Men, Lifestyle Who We Are About WebMD Site Map You are in Choose a Topic All Conditions ADD/ADHD Allergies Alzheimer's Arthritis Asthma Back Pain Breast Cancer Cancer Dental Depression Diabetes Eye Health Heart Disease Hepatitis HIV/AIDS Hypertension Men's Conditions Mental Health Migraines/Headaches Multiple Sclerosis Osteoporosis Parkinson's Sexual Conditions Stroke Weight Control Women's Conditions Beer, Spirits Increase Gout Risk But Wine May Be OK, Researcher Says By Salynn Boyles WebMD Medical News Reviewed By Michael Smith, MD on Thursday, April 15, 2004 April 15, 2004 For centuries, gout has been known as the "disease of kings" because overindulging in rich food and drink is a major cause of the painful joint condition. But it now appears that when it comes to alcohol, the biggest culprit is the beverage long favored by the common man. In the largest study of its kind, researchers found that as few as two to four beers a week increased the risk of gout by 25%. But men who drank at least two beers a day were more than 200% as likely to develop gout as non-beer drinkers. And the more beer they drank, the more likely they were to suffer an attack of gout. Liquor drinkers also suffered a gouty fate, though not as severely. As little as one liquor drink a month increased the risk, but the chance of gout jumped 60% with two or more liquor drinks a day.

77. All About Arthritis Information about gout, an arthritic condition involving needlelike crystals which deposit in the joints, causing swelling and extreme pain. http://www.allaboutarthritis.com/arthritis.cfm/about/164

78. Gout t. gout is caused by monosodium urate or uric acid crystal deposition within cartilage, bone, or periarticular tissues. 1. Distribution http://www.gentili.net/foot/gout.htm

var oMag; var oClick; onload=init; t GOUT is caused by monosodium urate or uric acid crystal deposition within cartilage, bone, or periarticular tissues. Distribution First metatarsophalangeal joint is most commonly affected, followed by the first interphalangeal joint and tarsometatarsal joints. Posterior calcaneal involvement has also been noted. The majority of first presentations are monoarticular. Bilateral and symmetric or asymmetric polyarticular involvement may be present within any of the foot joints. Erosion pattern: Acute, episodic soft tissue swelling may represent the earliest radiographic sign. Later, sharp, round or oval marginal joint erosions with sclerotic borders are classically seen with gout. These findings most commonly occur along the dorsum of the foot. Associated soft tissue tophi or intraosseous nodules may be present. "Overhanging margin" occur where the bone resorbs beneath a tophaceous nodule. Joint spaces are usually preserved, but ankylosis may rarely occur with advanced stages of gout. The aforementioned findings may be in different stages of progression with any given patient. Differential diagnosis: Concomitant osteoarthritis (especially of the tarsometatarsal joint) is common and should not be confused with gout. Joint space narrowing, as seen with advanced gout, may mimic rheumatoid arthritis.

79. Naturalhealthlink.com Detailed information on gout, its symptoms, treatment and diet changes that may be helpful. http://www.naturalhealthlink.com/ReferenceLibrary/healthnotes.asp?ArticleID=65&a

80. Johns Hopkins Arthritis Article On Gout History of gout. (ref 1) Serum uric acid level (mg/dl), Incidence of gout. 9.0, 7.08.9. 7.0–8.9, 0.5 037;. 7.0, 0.1%. (top of page). Acute gout Attack. http://www.hopkins-arthritis.som.jhmi.edu/other/gout.html

by Alan Matsumoto, M.D. History of Gout Clinical Presentation: Asymptomatic Hyperuricemia Acute Gout Attack Chronic Tophaceous Gout Treatments: Acute Attack Gout Prophylaxis Uric Acid Lowering Therapy Urate Nephropathy ... References History of Gout Perhaps the oldest known type of arthritis, gout or gouty arthritis has been described since Hippocrates in the 5 th Gout depicted as an evil demon attacking a toe. A gout sufferer helped onto his horse. The association of gout and uric acid has been known since the 19 th (top of page) Asymptomatic Hyperuricemia Incidence of gout (top of page) Acute Gout Attack An acute attack of gout is a highly inflammatory arthritis often with intense swelling, redness and warmth surrounding the joint. The inflammatory component is so intense, an acute attack of gout is often mistaken for a bacterial cellulitis. Even among other types of inflammatory arthritis, gout is considered the most painful with the patient unable to bear weight or put on a shoe over the affected joint and often prompting an off hour trip to the emergency room. Chills, a low grade fever and an elevated white blood cell count can occur, mimicking an infection. Characteristically, early gout attacks resolve spontaneously after 3 to 4 days. The first MTP joint (podagra) is the first joint affected in 50% of cases followed other lower extremity joints. Over 90% of patients who present with acute polyarticular gout have a history of podagra. The victim goes to bed and sleeps in good health. About 2 o'clock in the morning, he is awakened by a severe pain in the great toe; more rarely in the heel, ankle or instep. This pain is like that of a dislocation, and yet the parts feel as if cold water were poured over them. Then follows chills and shiver and a little fever. The pain which at first moderate becomes more intense. With its intensity the chills and shivers increase. After a time this comes to a full height, accommodating itself to the bones and ligaments of the tarsus and metatarsus. Now it is a violent stretching and tearing of the ligaments now it is a gnawing pain and now a pressure and tightening. So exquisite and lively meanwhile is the feeling of the part affected, that it cannot bear the weight of bedclothes nor the jar of a person walking in the room.

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