Gout is the most common inflammatory arthritis in men older than 40 years, affecting about 1-2% of adult men in Western countries. It accounts for about 5% of all cases of arthritis.Recent studies have observed an increased risk of gout among those who consumed the highest quintile of meat, seafood and alcohol. It presents as a recurrent, acute, monoarticular or oligoarticular arthritis. In some cases, it can progress to a chronic polyarticular arthritis associated with bony deformities.

Aggravated Factors

· Hyperuricemia, Alcohol, High meat and seafood intake, Medications (eg, diuretics, low-dose aspirin (< 2 g/day), cyclosporine, tacrolimus, ethambutol, pyrazinamide, nicotinic acid)

· Chronic Diseases such as Hypertension, Chronic kidney disease, Obesity, Hyperlipidemia, particularly hypertriglyceridemia, Insulin resistance, diabetes mellitus, metabolic syndrome, and Cardiovascular disease

Uric acid results from the breakdown of purines, which are part of all human tissue and are found in many foods If the body increases its production of uric acid or if the kidneys do not eliminate enough uric acid from the body, levels of it build up in the blood. Hyperuricemia, defined as serum urate level > 7 mg/dL in men and > 6 mg/dL in women, is the strongest risk factor for development of gout. Recent studies suggest that higher consumption of meat products and seafood conferred a higher risk of hyperuricemia and incident gout, whereas purine-rich vegetables and total protein did not, while high dairy intake appeared protective.

Causes

1. Overproduction of urate (endogenous or exogenous [dietary ] purine precursors) .

2. Underexcretion of urate (abnormal renal handling of urate) such as renal disease, lead nephropathy (saturnine gout), inhibition oftubular urate secretion (keto- and lactic acidosis), and miscellaneous causes such as hyperparathy- i roidism, hypothyroidism, and respiratory acidosis. : This group is responsible for 90% cases of hyperuricemia.

3. A combination of both processes.

24-hour urine collection is obtained for the determination of uric acid and creatinine excretion (to ensure an adequate 24-hour collection). On a regular purine diet, a urate value >800 mg/24 hrs suggests overproduction of uric acid. A 24-hour urate value <800 mg suggests underexcretion.

Several drugs could cause hyperuricemia due to decreased renal excretion of urate such as Cyclosporine, furosemide, Alcohol Ethambutol, Nicotinic acid Aspirin (low dose) , Thiazides Pyrazinamide

Hyperuricemia, resulting in one or more of the following manifestations: Gouty arthritis, Tophi (deposits of monosodium urate monohydrate crystal deposition occurring in articular, cartilaginous, and soft tissue: see the picture), Gouty nephropathy and Uric acid nephrolithiasis (uric acid calculi in the urinary tract).

85% of attacks of acute gouty arthritis are typically monoarticular and begin abruptly, increased during the night or early morning. The affected joint is painful, warm, red, and swollen. A low-grade fever may be present. The attacks often resolve spontaneously over 3- I 0 days.

Along with specific prescribed medications, it is typically recommended that people with gout reduce their intake of purine-rich foods such as Alcoholic beverages. Anchovies, sardines in oil, fish roes, Yeast. Organ meat (liver, kidneys, sweetbreads), dried beans, peas, Meat extracts, Mushrooms, spinach, asparagus and cauliflower.

Foods could help people with gout such as Dark berries, Tofu, salmon, flax or olive oil.

In addition to avoid purine-rich foods. It is important to drink plenty of water, exercise and maintain a healthy weight. Avoid a quick or extreme weight loss because it increase uric acid levels in the blood.