gout (podagra)

Metabolic disorder in which uric acid crystals accumulate in the joints. Hereditary factors are sometimes important; it can be passed by a daughter to her children, although she herself does not contract the disease. It is much more common in men than women. Uric acid is a normal breakdown product of cell protein, usually removed from the body by the kidneys; an attack of gout is often preceded by a (temporary) increase in blood-uric acid content, sometimes attributable to excessive uric acid production, sometimes to a kidney malfunction that makes them less able to excrete uric acid. The cause of over-production is usually not clear, but it is known that the treatment of cancer with cell-killing drugs can cause gout, because many cell proteins are broken down in the process. Accumulation of uric acid crystals in the joints causes an acute, painful inflammation reaction. In principle it can occur in any joint, but the most usual site is the big toes, possibly because the temperature is somewhat lower there. The pain occurs suddenly, and within a short time the joint is so sensitive that even the pressure of a blanket is. Painful. The skin is warm, red, shiny and swollen, and body temperature may rise. Attacks of gout tend to recur. After the first attack there is usally a gap of months or even years, then comes another attack, possibly in the same joint, possibly elsewhere. Often the attacks increase in frequency, and last for longer. Ultimately wear on the joint can cause pain between attacks. Uric acid crystals accumulate not only in the joints, but also in the cartilaginous tissue of the ear, for example, or in the kidneys, often causing kidney stones. Chronic gout can lead to malfunction of the kidneys. Treatment of gout is directed in the first place towards reducing the pain, but there are painkillers which should be avoided: aspirin, for example, increases the amount of uric acid in the blood. It is also important to prevent recurrence

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