Gout– a painful and common type of arthritis was historically known as a rich man's disease. It is due to the fact that, gout is caused by an excess of uric acid in the blood. This uric acid is produced in the body through the breakdown of purines-specific compounds that are found in certain foods such as meat, seafood and poultry. All of which are consumed in abundance by the 'rich-class.'
Uric acid is actually a waste product of human metabolism, and is normally excreted out through urine. But if too much uric acid is produced but insufficiently excreted, it accumulates in the body by forming crystals (tophi) and gets settled in the joints, soft tissues or organs, eventually leading to the disease known as gout.
Cases of gout have increased in the recent years due to an increase in the aging population, changes in lifestyle and dietary habits as well as increase in the use of certain drugs, which can lead to a high uric acid level in the body. This is alarming as the uric acid crystals (tophi) can cause pain and stiffness in the joints and time can wear away cartilages and bones, hence destroy the joints. Certain larger tophi accumulated under the skin can cause severe deformities.

Symptoms of Gout
This may vary depending on the stage or condition, but usual symptoms include-
Raised temperature, swelling and extreme tenderness in joints (usually the joints of a big toe).
Pain often starts during night, and may get worse quickly, lasting for hours.
Limited movement of the affected joint.
Purplish skin around the affected joint, the joint may seem infected.
Peeling and itching of the skin around the affected joint- this happens when the gout heals

Stages of Gout
Asymptomatic hyperuricemia: as the name suggests, symptoms won't be seen, only that the uric acid level rises in blood.
Acute gout: This is also known as 'flare up' or gout attack stage, where unbearable pain occurs but subsides within 3-10 days. It is due to a deposition of urate crystals.
Interval gout: This is the stage between two subsequent attacks; this period may last from months to years. Further urate crystals get deposited but pain is usually not experienced.
Chronic tophaceous gout: This is the final and most devastating stage. Patients may suffer from chronic arthritis as permanent damage has occurred to the joints. This stage is a bit rare, as it takes a long time for a person to reach this stage.

Risk Factors for Gout
Age and gender: Adults and males are more prone to gout, though post-menopausal women are not an exception.
Genetics: Patients who have a history of gout in the family are more at risk then those who don't.
Medications: Taking medications such as Diuretics or drugs containing Salicylate may trigger gout.
Obesity: Obese or overweight people are at risk of developing gout, as their body produces more uric acid than the average population.
Drinking alcohol: Alcohol interferes with the removal of uric acid from the body, hence forming a suitable ground for gout.
Diet rich in Purine: As mentioned earlier, high-purine diet increases the amount of uric acid formation in the body.
Certain health conditions: High blood pressure, diabetes, hypothyroidism and renal insufficiency are some of the diseases that increase the chances of gout.

When to Seek Medical Attention
Seek immediate medical attention if you experience any of the symptoms mentioned above, the doctor will run some blood tests and in some cases do an x-ray to see the level of uric acid and deposition of Tophi. They will then prescribe medicines that can prevent and even reverse the uric acid buildup.

Treatment for Gout
Strict rest of the affected joint is usually prescribed along with application of ice to reduce swelling. Some oral medications are also prescribed such as NSAIDs, Corticosteroids and Colchicine; all these drugs help in relieving pain and reducing inflammation.
Though rare, some patients may undergo surgery for the removal of large Tophi (urate crystals) that cause deformity or joint restriction.

Prevention for Further Attacks
If you have already encountered a gout attack, further attacks and deterioration can be prevented by following these measures:
Maintain a healthy weight
Stay away from alcohol
Limit meat and seafood
Take the medicines prescribed regularly

Foods Containing Purine  
Dried beans and peas
Liver
Beef Kidneys
Mushrooms
Brains
Sweetbreads

The writer is Research Physician, Centre for Child and Adolescent Health (CCAH), ICDDR,B.