Harvard Men's Health Watch

Gout: Joint pain and more

It starts with a bang, often in the dead of night. The pain is severe, almost unbearable, and fever may make you feel even worse. Lying still helps a bit, but even the touch of a sheet can be excruciating. And, worst of all, your distress may be greeted with a sly smile instead of supportive sympathy. You are suffering from gout, a common disease that's often misunderstood.

Myths and realities

Gout is an old disease, and erroneous beliefs about it are almost just as old. The name, in fact, is based on a misconception It's derived from a Latin word that means "a drop"; ancient physicians chose the name because they believed the pain resulted from a drop of "a bad humor." Over the centuries, gout was considered a rich man's disease, a product of overeating, excessive drinking, and corpulence. Modern research, however, shows that gout has no relationship to wealth or social status and little to diet and drink. But one traditional view has proved correct: Gout is a man's disease, occurring seven to nine times more often in men than women. It's also a common disease, striking an estimated 3.4 million American men annually. That makes gout the most prevalent form of inflammatory arthritis in men older than 40.

The chemical culprit

Gout is caused by an accumulation of uric acid. Uric acid has no useful function in the human body; it is simply a breakdown product of purines, a group of chemicals present in all body tissues and many foods. In normal circumstances, the body rids itself of uric acid by excreting it in the urine, keeping blood levels low. But some men have inherited a metabolic glitch that allows blood uric acids to rise; 90% of the time it's because the kidneys don't excrete enough uric acid, but sometimes the body just produces too much of the pesky chemical. Certain medications, such as low-dose aspirin, thiazide diuretics, and niacin, can also increase uric acid levels. Binge drinking, prolonged fasting, kidney disease, lead toxicity, extreme muscular exertion, and leukemia and lymphomas are much less frequent causes of high uric acid levels.

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