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Gout
Classification and external resources
Uric acid
ICD-10 M10.
ICD-9 274.0 274.1 274.8 274.9
OMIM 138900 300323
DiseasesDB 29031
eMedicine med/924  orthoped/124 emerg/221 med/1112 oph/506 radio/313
MeSH D006073

Gout (also called metabolic arthritis) is a disease created by a build up of uric acid. Uric acid (or urate) is an Organic compound of Carbon, Nitrogen, Oxygen and Hydrogen with the formula C5H4N4O3 The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings M00-M99 - Diseases of the Musculoskeletal system and Connective tissue (M00-M25 Arthropathies (M00-M03 Infectious arthropathies The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Mendelian Inheritance in Man project is a Database that catalogues all the known Diseases with a genetic component, and—when possible—links them The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Uric acid (or urate) is an Organic compound of Carbon, Nitrogen, Oxygen and Hydrogen with the formula C5H4N4O3 In this condition, monosodium urate or uric acid crystals are deposited on the articular cartilage of joints, tendons and surrounding tissues due to elevated concentrations of uric acid in the blood stream. In Materials science, a crystal is a Solid in which the constituent Atoms Molecules or Ions are packed in a regularly ordered repeating Cartilage is a type of dense Connective tissue. It is composed of specialized cells called chondrocytes that produce a large amount of extracellular matrix This provokes an inflammatory reaction of these tissues.

Contents

Signs and symptoms

The Gout, Cartoon by James Gillray (1799). The artist memorably illustrates the excruciating pain and swelling that are symptoms of the disease.
The Gout, Cartoon by James Gillray (1799). James Gillray, sometimes spelled Gilray (born August 13, 1757 in Chelsea; died June 1, 1815) was a British The artist memorably illustrates the excruciating pain and swelling that are symptoms of the disease.

Gout is characterized by excruciating, sudden, unexpected, burning pain, as well as swelling, redness, warmth, and stiffness in the affected joint. This occurs commonly in men in their toes but can appear in other parts of the body and affects women as well. Low-grade fever may also be present. The patient usually suffers from two sources of pain. The crystals inside the joint cause intense pain whenever the affected area is moved. The inflammation of the tissues around the joint also causes the skin to be swollen, tender and sore if it is even slightly touched. For example, a blanket or even the lightest sheet draping over the affected area could cause extreme pain.

Gout usually attacks the big toe (approximately 75 percent of first attacks); however, it also can affect other joints such as the ankle, heel, instep, knee, wrist, elbow, fingers, and spine. The hallux, commonly referred to as the big toe (also as great toe or thumb toe) even though it's not actually the biggest toe on the foot of some In some cases, the condition may appear in the joints of small toes that have become immobile due to impact injury earlier in life, causing poor blood circulation that leads to gout.

Patients with longstanding hyperuricemia (see below) can have uric acid crystal deposits called tophi (singular: tophus) in other tissues such as the helix of the ear. Hyperuricemia ( American English) or hyperuricaemia ( British English) is the presence of high levels of Uric acid in the blood A tophus (Latin "stone" plural tophi) is a deposit of Crystallised monosodium urate in people with longstanding Hyperuricemia A tophus (Latin "stone" plural tophi) is a deposit of Crystallised monosodium urate in people with longstanding Hyperuricemia The prominent rim of the auricula is called the helix. Where the helix turns downward behind a small tubercle is frequently seen the auricular tubercle of Darwin Elevated levels of uric acid in the urine can lead to uric acid crystals precipitating in the kidneys or bladder, forming uric acid kidney stones. The kidneys are complicated organs that have numerous biological roles In Anatomy, the urinary bladder is a hollow muscular, and distensible (or elastic organ that sits on the Pelvic floor in Mammals It is the Kidney stones, also called renal calculi, are solid concretions (crystal aggregations of dissolved minerals in Urine; calculi typically form

Diagnosis

A definitive diagnosis of gout is from light microscopy of fluid aspirated from the joints (this test may be difficult to perform) to demonstrate intracellular monosodium urate crystals in synovial fluid polymorphonuclear leukocytes. Diagnosis is the identification by Process of elimination, of the nature of anything Microscopy is the technical field of using microscopes to view samples or objects Not to be confused with Intercellular, meaning "between cells" Synovial fluid is a thick stringy fluid found in the cavities of Synovial joints With its egg-like consistency ("synovial" partially derives from ovum, Granulocytes are a category of White blood cells characterised by The urate crystal is identified by strong negative birefringence under polarised microscopy and its needle-like morphology. Birefringence, or double refraction, is the decomposition of a ray of Light into two rays (the ordinary ray and the extraordinary ray A trained observer does better in distinguishing them from other crystals.

Hyperuricemia is a common feature, although urate levels are not always raised. Hyperuricemia ( American English) or hyperuricaemia ( British English) is the presence of high levels of Uric acid in the blood [1] Hyperuricemia is defined as a plasma urate (uric acid) level greater than 420 μmol/L (7. Blood plasma is the Liquid component of Blood, in which the Blood cells are suspended 0 mg/dL) in males (or 380 μmol/L in females). However, a high uric acid level does not necessarily mean a person will develop gout. Uric acid (or urate) is an Organic compound of Carbon, Nitrogen, Oxygen and Hydrogen with the formula C5H4N4O3 Urate is within the normal range in up to two-thirds of cases. [2] If gout is suspected, the serum urate test should be repeated once the attack has subsided. Other blood tests commonly performed are full blood count, electrolytes, renal function, thyroid function tests and erythrocyte sedimentation rate (ESR). A complete blood count ( CBC) also known as full blood count ( FBC) or full blood exam ( FBE) or blood panel, is An electrolyte is any substance containing free Ions that behaves as an electrically conductive medium Renal function, in Nephrology, is an indication of the state of the Kidney and its role in Renal physiology. Thyroid function tests ( TFTs) is a collective term for Blood tests used to check the function of the Thyroid. The erythrocyte sedimentation rate (ESR also called a sedimentation rate, sed rate, or Biernacki Reaction, is the rate at which Red blood cells This helps to exclude other causes of arthritis, most notably septic arthritis, and to investigate any underlying cause for the hyperuricaemia. Arthritis (from Greek arthro-, joint + -itis, inflammation plural arthritides is a group of conditions involving damage to the Joints of the body Septic arthritis is the invasion of a Joint by an Infectious agent which produces Arthritis.

Pathogenesis

Gout occurs when mono-sodium urate crystals form on the articular cartilage of joints, on tendons, and in the surrounding tissues. Purine metabolism gives rise to uric acid, which is normally excreted in the urine. Many organisms have Metabolic pathways to synthesize and break down Purines Synthesis Purines are biologically synthesized as Nucleotides (bases attached Uric acid is more likely to form into crystals when there is a hyperuricemia, although it is 10 times more common without clinical gout than with it. Hyperuricemia ( American English) or hyperuricaemia ( British English) is the presence of high levels of Uric acid in the blood [3]

Purines can be generated by the body via breakdown of cells in normal cellular turnover, or can be ingested in purine-rich foods such as seafood. Purine ( 1) is a heterocyclic Aromatic Organic compound, consisting of a Pyrimidine ring fused to an Imidazole ring The kidneys are responsible for approximately two-third of uric acid excretion, with the gut responsible for the rest. It may be possible that defects in the kidney that may be genetically determined are responsible for the predisposition of individuals for developing gout.

There are also different racial propensities to develop gout. Gout is high among the peoples of the Pacific Islands, and the Māori of New Zealand, but rare in the Australian aborigine despite the latter's higher mean concentration of serum uric acid. This article discusses the Māori people of New Zealand For their language see Māori language, and for other meanings see Māori (disambiguation. [4] In the United States, gout is twice as prevalent in African American males as it is in European-Americans. [5]

A seasonal link also may exist, with significantly higher incidence of acute gout attacks occurring in the spring. [6][7]

Hyperuricemia is considered an aspect of metabolic syndrome, although its prominence has been reduced in recent classifications. Metabolic syndrome is a combination of medical disorders that increase the risk of developing Cardiovascular disease and diabetes. This explains the increased prevalence of gout among obese individuals. Obesity is a condition in which excess Body fat has accumulated to such an extent that health may be negatively affected

Gout is a form of arthritis that affects mostly men between the ages of 50 and 60. The high levels of uric acid in the blood are caused by protein rich foods. Alcohol intake often causes acute attacks of gout and hereditary factors may contribute to the elevation of uric acid. Typically, persons with gout are obese, predisposed to diabetes and hypertension, and at higher risk of heart disease. Gout is more common in affluent societies due to a diet rich in proteins, fat, and alcohol. When it follows as a consequence of other health conditions such as renal failure, it is often regardless of the person's lifestyle. Renal failure or kidney [8] Lin, et al have statistical evidence linking gout to lead poisoning[9] and lead level in the body is significantly correlated with urate excretion and gout. [10] It is known that lead sugar was used to sweeten wine, and that chronic lead poisoning is a cause of gout,[11][12] which condition is then known as saturnine gout, because of its association with alcohol and excess. Lead(II acetate is a Chemical compound, a white crystalline substance with a Sweetish taste Lead poisoning (also known as saturnism, plumbism, or painter's colic) is a medical condition caused by increased levels of the metal Lead in [13]

Gout also can develop as co-morbidity of other diseases, including polycythaemia, leukaemia, intake of cytotoxics, obesity, diabetes, hypertension, renal disorders, and hemolytic anemia. Polycythemia (or polycythaemia or erythrocytosis) is a condition in which there is a net increase in the total number of Blood cells, primarily Red Leukemia or leukaemia (Greek leukos λευκός, "white" aima αίμα, "blood" is a Cancer of the Blood Cytotoxicity is the quality of being toxic to cells Examples of toxic agents are a Chemical substance, an Immune cell or some types of Venom Obesity is a condition in which excess Body fat has accumulated to such an extent that health may be negatively affected Diabetes mellitus (ˌdaɪəˈbiːtiːz or /ˌdaɪəˈbiːtəs/ /məˈlaɪtəs/ or /ˈmɛlətəs/ often referred to simply as diabetes ( Ancient Greek: grc Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the Blood pressure is chronically elevated The kidneys are complicated organs that have numerous biological roles Hemolytic anemia is Anemia due to Hemolysis, the abnormal breakdown of Red blood cells (RBCs either in the Blood vessels (intravascular hemolysis This form of gout is often called secondary gout. Diuretics (particularly thiazide diuretics) have traditionally been blamed for precipitating attacks of gout, but a Dutch case-control study from 2006 appears to cast doubt on this conclusion. A diuretic is any Drug that elevates the rate of urination ( Diuresis) Thiazide is a term used to describe a type of molecule and a class of Diuretic. [14]

Gout with tophi on elbow and knee.
Gout with tophi on elbow and knee.

Treatment

Acute attacks

The first line of treatment should be pain relief. Once the diagnosis has been confirmed, the drugs of choice are indomethacin, other nonsteroidal anti-inflammatory drugs (NSAIDs), oral glucocorticoids[15], or intra-articular glucocorticoids administered via a joint injection. Indometacin ( INN Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAID s or NAID s, are drugs with Analgesic, Antipyretic and in higher Glucocorticoids (GC are a class of Steroid hormones characterised by an ability to bind with the glucocorticoid receptor ( GR) and trigger similar effects Glucocorticoids (GC are a class of Steroid hormones characterised by an ability to bind with the glucocorticoid receptor ( GR) and trigger similar effects In Medicine, a joint injection ( intra-articular injection) is a procedure used in the treatment of inflammatory joint conditions, such as Rheumatoid

Colchicine was previously the drug of choice in acute attacks of gout, as it impairs the motility of granulocytes and can prevent the inflammatory phenomena that initiate an attack. Colchicine is a highly poisonous Natural product and Secondary metabolite, originally extracted from plants of the genus Colchicum ( Autumn Granulocytes are a category of White blood cells characterised by Colchicine should be taken within the first 12 hours of the attack and usually relieves the pain within 48 hours, although side effects (gastrointestinal upset such as diarrhea and nausea) can complicate its use. In Medicine, diarrhea, also spelled diarrhoea (see spelling differences) is frequent loose or liquid Bowel movements Acute diarrhea Nausea ( Latin: Nausea, Greek:, " Sea-sickness " also called wamble) is the sensation of unease and discomfort NSAIDs are the preferred form of analgesia for patients with gout.

A randomized controlled trial found similar benefit from nonsteroidal anti-inflammatory drugs and oral glucocorticoids; however, less adverse drug reactions occurred in the glucocorticoids group. A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAID s or NAID s, are drugs with Analgesic, Antipyretic and in higher Glucocorticoids (GC are a class of Steroid hormones characterised by an ability to bind with the glucocorticoid receptor ( GR) and trigger similar effects An adverse drug reaction (abbreviated ADR) or adverse drug event (abbreviated ADE) is an expression that describes the unwanted negative consequences Glucocorticoids (GC are a class of Steroid hormones characterised by an ability to bind with the glucocorticoid receptor ( GR) and trigger similar effects [16] In the nonsteroidal anti-inflammatory drugs group, each patient initially received diclofenac (75 mg) intramuscularly, indomethacin 50 mg orally, and acetaminophen 1 g orally. Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAID s or NAID s, are drugs with Analgesic, Antipyretic and in higher Diclofenac (marketed as Flector patch, Voltaren, Voltarol, Diclon, Dicloflex Difen, Difene, Cataflam Indometacin ( INN Paracetamol ( INN) (ˌpærəˈsiːtəmɒl -ˈsɛtə- or acetaminophen ( USAN) is a widely-used Analgesic and Antipyretic Medication The patient was received a 5-days of indomethacin (50 mg orally every 8 hours for 2 days, followed by indomethacin 25 mg every 8 hours for 3 days), and acetaminophen 1 g every 6 hours as needed. The glucocorticoids patients received prednisolone 30 mg orally, and acetaminophen 1 g orally. Glucocorticoids (GC are a class of Steroid hormones characterised by an ability to bind with the glucocorticoid receptor ( GR) and trigger similar effects Prednisolone is the active metabolite of Prednisone. Uses It is a Corticosteroid drug with predominantly Glucocorticoid and low Mineralocorticoid The patient was then given prednisolone 30 mg orally once per day for five days.

Before medical help is available, some over-the-counter medications can provide temporary relief from pain and swelling. NSAIDs such as ibuprofen can reduce the pain and inflammation slightly, although aspirin should not be used as it can worsen the condition. Ibuprofen ( INN) (ˌaɪbjuːˈpɹəʊfɛn (from the now outdated nomenclature i so- bu tyl- pro panoic- phen olic acid is a Non-steroidal Aspirin, or acetylsalicylic acid (ASA (əˌsɛtɨlsælɨˌsɪlɨk ˈæsɨd is a Salicylate drug, often used as an Analgesic to relieve This is because aspirin raises plasma uric acid levels even at low doses by inhibiting uric acid secretion in the renal tubules. Aspirin also reduces vasodilatation due to inhibition of prostaglandin PGE2 and PGI2 synthesis in the renal medulla and glomeruli respectively (see mechanism of action of aspirin). A prostaglandin is any member of a group of Lipid compounds that are derived enzymatically from Fatty acids and have important functions in the Animal body The renal medulla is the innermost part of the Kidney. The renal medulla is split up into a number of sections known as the Renal pyramids. A glomerulus is a Capillary tuft surrounded by Bowman's capsule in Nephrons of the vertebrate Kidney. Aspirin causes several different effects in the body mainly the reduction of inflammation, Analgesia (relief of pain Bleeding and the prevention of This may be a contra-indication for the use of aspirin for gout pain as well.

The anti-hemorrhoidal ointment Preparation H can reduce gout-induced skin swelling temporarily. Hemorrhoids ( AmE) haemorrhoids ( BrE) emerods, or piles are varicosities or swelling and Inflammation An ointment is a viscous semisolid preparation used topically on a variety of body surfaces Preparation H is a brand of medications used in the treatment of Hemorrhoids It was originally packaged in a tube like Toothpaste, with a similar consistency Ice may be applied for 20 to 30 minutes several times a day, and a randomized controlled trial found that patients who used ice packs had better relief of pain without side effects. A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare [17] Since gout is caused by crystals, it has been suggested that keeping very well hydrated and heating the affected joint in hot water (rather than cooling with ice) will promote the dissolution and clearance of the urate crytals. In Materials science, a crystal is a Solid in which the constituent Atoms Molecules or Ions are packed in a regularly ordered repeating Uric acid (or urate) is an Organic compound of Carbon, Nitrogen, Oxygen and Hydrogen with the formula C5H4N4O3 [18] Keeping the affected area elevated above the level of the heart also may help. Professional medical care is needed for long-term management of gout.

Due to swelling around affected joints for prolonged periods, shedding of skin may occur. This is particularly evident when small toes are affected and may promote fungal infection in the web region if dampness occurs, and treatment is similar to that for common athlete's foot. Athlete's foot, also called Tinea Pedis, is a Parasitic fungal infection of the epidermis of the human foot

Some sufferers of gout report an aggravation of the condition in the knees and toes associated with long periods of immobility, such as when sitting at a computer desk for long hours. Sufferers who notice early swelling or early pain may appear to be able to arrest the aggravation when medical treatment is applied before the condition gets worse. Where this is the case, a medically prescribed anti-inflammatory oral treatment taken with food and bed rest may provide relief within 6 to 8 hours. Bed rest is a Doctor's prescription to spend a longer period of time in bed

Another possibility is use of acetazolamide, one of the first diuretics discovered. Acetazolamide, sold under the trade name Diamox, is a Carbonic anhydrase inhibitor that is used to treat Glaucoma, Epileptic seizures Benign This drug inhibits the action of carbonic anhydrase on the proximal convoluted tubules within the kidneys, which effectively inhibits reabsorption of bicarbonate, thus alkalinizing the urine. In Inorganic chemistry, bicarbonate ( IUPAC -recommended nomenclature hydrogencarbonate) is an intermediate form in the Deprotonation After two to three days of usage, the diuretic effects of this drug decline because of increased downstream reabsorption of ions and water by the renal tubules; however, the alkalinization of urine persists, and this basic urine attracts weak acids such as uric acid and cystine into the urine, thus increasing their urinary excretion. 35

Chronic joint changes

For extreme cases of gout, surgery may be necessary to remove large tophi and correct joint deformity.

Prevention

Medications

Diet

See Saag and Choi, 2006, an open-access review article, for detailed references and further information. [31]

The serum level of uric acid is the primary risk factor for gout. The serum level is the result of both intake (diet) and output (excretion). Diet should be low fat and low protein.

Reduce intake of purines

The solubility threshold for uric acid is approximately 6. 7 mg/dl; above this threshold crystals may form. Healthy subjects in the Normative Aging Study who had serum levels of uric acid over 9. 0 mg/dl suffered a 22% incidence of gout over six years, compared to less than one percent for those with 7. 0-8. 9 mg/dl. The average uric acid level in men is 5. 0 mg/dl, and substitution of a purine-free formula diet reduces this to 3. 0 mg/dl. A purine-restricted diet lowers the level nearly as much (1-2 mg/dl).

A diet low in purines reduces the serum level of uric acid, unless these levels are caused by other health conditions and not as responsive to dietary changes. For notable sources of dietary purines, see "Foods to avoid" section below.

Protein is a crude proxy for purines; a more precise proxy is muscle. Apart from the notable dietary purines above, the main source of dietary purines is DNA and RNA, via their bases adenine and guanine. Deoxyribonucleic acid ( DNA) is a Nucleic acid that contains the genetic instructions used in the development and functioning of all known Ribonucleic acid ( RNA) is a Nucleic acid that consists of a long chain of Nucleotide units Adenine is a Purine with a variety of roles in Biochemistry including Cellular respiration, in the form of both the energy-rich Adenosine Guanine is one of the five main Nucleobases found in the Nucleic acids DNA and RNA, the others being Adenine, Cytosine, All sources of dietary protein supply some purines, but some sources provide far more purines than others. Meat (particularly dark meat) and seafood are high in purine because muscle cells are packed with mitochondria, which have their own DNA and RNA. Muscle (from Latin musculus, diminutive of mus "mouse" is contractile tissue of the body and is derived from the In Cell biology, a mitochondrion (plural mitochondria) is a membrane-enclosed Organelle found in most eukaryotic cells. In a large prospective study, high consumption of meat and seafood were found associated with an elevated risk of gout onset (41% and 50%, respectively). High consumption of dairy products, high in protein but very low in DNA and RNA, was associated with a 44% decrease in the incidence of gout. Consumption of the more purine-rich vegetables or a high protein diet per se had no significant correlation.

Men who consume two or more sugary soft drinks a day have an 85% higher risk of gout compared with those who drink less than one a month. [2] This is because soft drinks contain large quantities of high-fructose corn syrup (HFCS) (read label on any soft drink), which results in Hyperuricemia in blood. High-fructose corn syrup (HFCS is any of a group of Corn syrups that has undergone Enzymatic processing to increase its Fructose content and is then mixed Hyperuricemia ( American English) or hyperuricaemia ( British English) is the presence of high levels of Uric acid in the blood [32][33] Hyperuricemia, in turn predispose the body for gout. [34]

Consumption of beer is associated with a 49% increase in relative risk per daily 12-oz serving. By contrast, consumption of spirits was associated with only a 15% increase in relative risk, and no association at all was found with consumption of wine.

Some medical drugs are purine-based. Notable among these are the purine-analog antimetabolite drugs, sometimes used as chemotherapy agents. An antimetabolite is a chemical with a similar structure to a substance (a Metabolite) required for normal biochemical reactions yet different enough to interfere with the normal Chemotherapy, in its most general sense refers to treatment of disease by chemicals that kill cells specifically those of micro-organisms or Cancer.

Increase output of uric acid

As mentioned above, medicines to induce uric acid output are called uricosuric drugs. Uricosuric Medications ( Drugs are substances that increase the excretion of Uric acid in the Urine, thus reducing uric acid concentrations in Two such drugs are Probenecid and Sulfinpyrazone. Probenecid is a Uricosuric drug primarily used in treating Gout or Hyperuricemia, that increases uric acid removal in the urine Sulfinpyrazone is a Uricosuric medication used to treat Gout.

Other approaches

Additional dietary recommendations can be made which reduce gout indirectly, hypertension, cardiovascular disease, diabetes, and metabolic syndrome. Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the Blood pressure is chronically elevated Cardiovascular disease or cardiovascular diseases refers to the class of diseases that involve the Heart or Blood vessels ( arteries and Diabetes mellitus (ˌdaɪəˈbiːtiːz or /ˌdaɪəˈbiːtəs/ /məˈlaɪtəs/ or /ˈmɛlətəs/ often referred to simply as diabetes ( Ancient Greek: grc Metabolic syndrome is a combination of medical disorders that increase the risk of developing Cardiovascular disease and diabetes.

The following suggestions do not meet with universal approval among medical practitioners.

Low purine diet:

History

Writing ca. 30 AD, Aulus Cornelius Celsus appeared to recognize many of the features of gout, including its link with a urinary solute, late onset in women, linkage with alcohol, and perhaps even prevention by dairy products. Aulus Cornelius Celsus (ca 25 BC—ca 50 was a Roman encyclopedist and Physician. [4] "Again thick urine, the sediment from which is white, indicates that pain and disease are to be apprehended in the region of joints or viscera. " and "Joint troubles in the hands and feet are very frequent and persistent, such as occur in cases of podagra and cheiragra. These seldom attack eunuchs or boys before coition with a woman, or women except those in whom the menses have become suppressed. Upon the commencement of pain blood should be let; for when this is carried out at once in the first stages it ensures health, often for a year, sometimes for always. Some also, when they have washed themselves out by drinking asses' milk, evade this disease in perpetuity; some have obtained lifelong security by refraining from wine, mead and venery for a whole year; indeed this course should be adopted especially after the primary attack, even although it has subsided. "

The Roman gladiatorial surgeon Galen described gout as a discharge of the four humors of the body in unbalanced amounts into the joints. Ancient Rome was a Civilization that grew out of a small agricultural community founded on the Italian Peninsula as early as the 10th century BC Galen ( Greek: Γαληνός Galēnos; Latin: Claudius Galenus, Aelius Galenus, Claudius Aelius Galenus, or Erich Adickes, Eduard Spränger, Ernst Kretschmer, and Erich Fromm all theorized on the four temperaments (with different names and greatly The Latin term for a drop, as a drop of discharge, is gutta -- the term gout descends from this word. Latin ( lingua Latīna, laˈtiːna is an Italic language, historically spoken in Latium and Ancient Rome.

Notable sufferers

Notable sufferers of gout have included:

Royalty and nobility

Government and politics

Military and navy

Fine and performing arts

  • Roe Conn
  • Bobby Hill
  • Harry Judd
  • Jared Leto
  • Sir Laurence Olivier
  • Peter Paul Rubens
  • George Lopez
  • Dr. Anne (6 February 1665 – 1 August 1714 became Queen of England, Scotland and Ireland on 8 March 1702 succeeding William III of England and II of Charles IV ( Czech: Karel IV, German: Karl IV, Hungarian: IV Károly; 14 May 1316 &ndash Charles V (24 February 1500 &ndash 21 September 1558 was Frederick II (Friedrich II January 24 1712 August 17 1786) was a King of Prussia (1740&ndash1786 from the Henry VIII (28 June 1491 &ndash 28 January 1547 was King of England and Lord of Ireland, later King of Ireland and claimant to the Kingdom of Napoléon III, also known as Louis-Napoléon Bonaparte (full name Charles Louis Napoléon Bonaparte) (20 April 1808 9 January 1873 was the first President Christopher Columbus (1451 &ndash May 20 1506 was an Italian Navigator, colonizer Benjamin Disraeli 1st Earl of Beaconsfield, KG, PC, FRS (born Benjamin D'Israeli; 21 December 1804 &ndash 19 April 1881 was Benjamin Franklin ( April 17 1790 was one of the Founding Fathers of the United States of America. John Hancock ( October 8 1793 was a Massachusetts merchant and prominent patriot of the American Revolution. Thomas Jefferson (April 13 1743 – July 4 1826 was the third President of the United States (1801–1809 the principal author of the Declaration of Independence George Mason IV ( December 11, 1725 &ndash October 7, 1792) was a United States patriot, statesman and delegate from Jeff Mullis is a State senator of the Republican Party representing the 53rd district in the Georgia State Senate. William Pitt 1st Earl of Chatham PC (15 November 1708 &ndash 11 May 1778 was a British Whig Statesman who achieved his greatest fame as Early years Kublai Khan studied Chinese culture and became enamoured of it Lennart Torstenson, Count of Ortala, Baron of Virestad ( 17 August 1603 – 7 April 1651) was Anthony Wayne (January 1 1745–December 15 1796 was a United States Army general and statesman Roe B Conn (born in Chicago on 6 June 1964) is an American radio Talk show host who is the host of The Roe Conn Show which Robert Jeffrey "Bobby" Hill is a character on the animated series King of the Hill and is voiced by Pamela Adlon (sometimes as Pamela Segall Harry Mark Christopher Judd, (born December 23, 1985 in Chelmsford, Essex, England Jared Joseph Leto (born December 26, 1971) is an American Actor and Musician. Laurence Kerr Olivier Baron George Lopez (born April 23, 1961) is a Mexican American Comedian and Actor. Jerell Chua
  • Johnny Vegas
  • Maurice Cheeks
  • Harald Morten Evensen, a. Johnny Vegas (born 11 September, 1971 as Michael Joseph Pennington) is an English Actor and Comedian. Maurice "Mo" Edward Cheeks (born September 8 1956 in Chicago Illinois) is a retired American professional Basketball player k. a. Sid Psoriasis

Literature

Science and mathematics

Sports

Philosophy

Religion

See also

References

  1. ^ Sturrock R (2000). "Gout. Easy to misdiagnose". BMJ 320 (7228): 132–3. PMID 10634714.  
  2. ^ Siva C, Velazquez C, Mody A, Brasington R (2003). "Diagnosing acute monoarthritis in adults: a practical approach for the family physician". Am Fam Pghysician 68 (1): 83–90. PMID 12887114.  
  3. ^ Virsaladze D, Tetradze L, Djavashvili L, Esakia N, Tananashvili D. (2007). "Levels of uric Acid in serum in patients with metabolic sypfoirefudvhfduyvcjvhfgndrome. ". Georgian Med News 146: 34–7. PMID 17595458.  
  4. ^ Roberts-Thomson R, Roberts-Thomson P (1999). "Rheumatic disease and the Australian aborigine". Ann Rheum Dis 58 (5): 266&ndasgh;70. PMID 10225809.  
  5. ^ Rheumatology Therapeutics Medical Center. What Are the Risk Factors for Gout?. Retrieved on 2007-01-26. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 1340 - King Edward III of England is declared King of France.
  6. ^ Schlesinger N, Gowin KM, Baker DG, Beutler AM, Hoffman BI, Schumacher HR Jr. . Acute gouty arthritis is seasonal.. Retrieved on 2007-09-27. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 489 - Odoacer attacks Theodoric at the Battle of Verona and is defeated again
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External links

Dictionary

gout

-noun

  1. (pathology, not countable) An extremely painful inflammation of joints, especially of the big toe, caused by a metabolic defect resulting in the accumulation of uric acid in the blood and the deposition of urates around the joints.
  2. a spurt or splotch (usually followed by the preposition of)
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