What is it?

Gout is a chronic autoinflammatory disease with regular acute flares, which cause very painful joint inflammation . It occurs when there is too much uric acid in the blood. This leads to accumulation of uric acid crystals in the joints and the surrounding tissues, causing inflammation and gout attacks .

“Gout is one of the oldest known diseases. The Egyptians noted the disease in 2640 BC, and the ancient Greek physician Hippocrates called it “foot trap”. More recently, it was also considered to be an “aristocratic disease”: affecting only those who could afford rich food and beverages.”

How common is it?

Gout is common in industrialised countries, especially in older adult men. In Europe, the number of people with gout ranges from 1-5 people in 100.[3, 4, 6] Gout is most common in men over 40 years of age and in women after menopause. The number of people affected by gout has been on the rise for several decades.

Frequency of gout in various regions [1–11] as before

What are the symptoms ?

Aside from inflammation (redness, swelling), acute gout attacks very quickly involve excruciating pain as well. After 8-12 hours, they reach their maximum intensity. Gout often occurs in the legs or feet and often affects a single joint, especially the large joint of the big toe.

Often people with gout also experience symptoms that affect the entire body, such as mild fever, chills and a feeling of being unwell. Left untreated, the most intense phase of the first attack usually lasts 3-4 days, with the pain gradually subsiding over the following 3-4 days. Typically with gout, the pain and inflammation disappear on their own.

What typically happens over the course of the illness?

Joints and body parts affected by gout (modified according to [12])

Long-term disease course associated with inadequately treated gouty arthritis (graphic representation, modified according to [15])

How is it caused?

Gout is an autoinflammatory condition, which means the innate immune system becomes inappropriately activated. During an acute gout attack the presence of uric acid crystals in the joint leads to the release of IL-1β , a messenger of the immune system which triggers an inflammatory response.[16] [12]

Uric acid crystals promote the release of IL-1β in joints (modified according to [17])

Status: 2016-01-04

[1] Badley E, DesMeules M: Arthritis in Canada: an ongoing challenge. Public Health Agency of Canada, 2003.
[2] Lawrence RC, Felson DT, Helmick CG et al. Arthritis Rheum. 2008;58:26–35.
[3] Annemans L, Spaepen E, Gaskin M et al. Ann Rheum Dis. 2008;67:960–6.
[4] Zalokar J, Lellouch J, Claude JR. Sem Hop Paris. 1981;57(13-14);664–70.
[5] Cañete J. ed. Manual SER de Enfermedades Reumáticas. Spanish Society of Rheumatology, 2008.
[6] Anagnostopoulos I, Zinzaras E, Alexiou I et al. BMC Musculoskelet Disord. 2010;11:98.
[7] Joshi VL, Chopra A. J Rheumatol. 2009;36:614–22.
[8] March L. Australian Institute of Health and Welfare, 2006.
[9] Klemp P, Stansfield SA, Castle B et al. Ann Rheum Dis. 1997;56:22–6.
[10] Zeng Q, Wang Q, Chen R et al. Chin Med J (Engl). 2003;116:66–9.
[11] Miao Z, Li C, Chen Y, Zhao S, et al. J Rheumatol. 2008;35:1859–64.
[12] Terkeltaub R, Edwards NL. Gout: Diagnosis and Management of Gouty Arthritis and Hyperuricemia. New York: Professional Communications; 2010.
[13] Mandell BF. Cleve Clin J Med. 2008;75(Suppl 5):S5–8.
[14] Schumacher HR. Cleve Clin J Med. 2008;75(Suppl 5):S2–4.
[15] Edwards NL. Gout: Clinical features. In: Klippel JH, Stone JH, Crofford LJ, White PH, eds. Primer on the Rheumatic Diseases. 13th ed. New York: Springer; 2008:241–249.
[16] Dinarello CA. Arthritis Rheum. 2010;62(11):3140–4.
[17] Busso N. Arthritis Res Ther. 2010;12:206–13.

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June 2016 - GLDEIM/ACZ885/0075