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Gout is a metabolic disorder that results from high levels of uric acid (a waste product of cell metabolism) in the blood. The condition can lead to joint inflammation, deposits of uric acid in and around the joints, reduced kidney function, and sometimes the development of kidney stones (see page 289).

Gout is nine times more common in men than in women. Risk factors for gout include obesity, moderate to heavy alcohol consumption, high blood pressure, and kidney disorders. Certain drugs (such as aspirin) can worsen gout, and certain diseases that affect kidney function (such as diabetes and sickle-cell disease) can be a factor. Acute attacks of gout can be brought on by dehydration, joint injury, fever, large meals, high alcohol intake, stress, or recent surgery. Certain foods, such as shellfish, sardines, and organ meats, also may trigger attacks.

The small joint at the base of the big toe is the most common location for an acute gout attack. Other joints affected may include the ankles, knees, wrists, fingers, and elbows. An acute gout attack often begins at night, with severe pain and sometimes a fever. The attack may subside in several hours or several days but usually recurs at irregular intervals.

The symptoms alone usually are sufficient to diagnose gout, but your doctor can confirm the diagnosis by examining your blood for elevated uric acid levels and your joint fluid for signs of uric acid crystals.

Future attacks can be prevented by increasing fluid consumption (at least eight 8-ounce glasses every day), losing weight (see page 73), reducing alcohol intake, modifying your diet, and taking nonsteroidal anti-inflammatory drugs (such as ibuprofen) to relieve the pain and inflammation and medications (such as allop-urinol or probenecid) to lower blood levels of uric acid.

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