A guide to gout and pseudogout

If you're worried about your gout diagnosis, or feel the following symptoms may apply to you, have no fear: this handy guide should help.

• Gout attacks occur when excess levels of uric acid in the blood form needle-like crystals that typically settle in one of the joints — most commonly in the big toe but sometimes in the knee or knuckles.
• Once in the joint, these abrasive particles can cause excruciating pain and inflammation. The condition has afflicted royalty and the well-to-do through the ages.
• Causes and symptomsIt's uncertain what precipitates a gout attack, though some factors may put you at risk.
• A quarter of those who suffer from gout have a family history of the illness and three-quarters have high triglyceride levels.
• Men who gain a lot of weight between ages 20 and 40 are particularly vulnerable. Excessive alcohol intake, high blood pressure, kidney disease, exposure to lead, crash diets and certain medications (including antibiotics, diuretics and chemotherapy drugs) may also play a role.
• For some people, eating foods high in chemicals called purines (such as liver or anchovies) can cause flare-ups.
• Gout is diagnosed by identifying uric acid crystals in synovial fluid, usually by removing fluid from the joint through a needle.
• X-rays can be helpful and may reveal uric acid deposits and bone damage if you have suffered from repeated inflammations.

• Drinking up to two litres of water a day helps to incease the excretion of uric acid.
• Avoiding purine-rich foods (liver and anchovies, seafoods, dried peas and beans) can help prevent gout attacks. Keeping your weight down can also help, as does avoiding foods that are high in fat and refined carbohydrates.
• The biggest treatment advance in managing gout is drugs like allo-purinol, probenecid and sulfinpyrazone.
• These drugs prevent gout attacks by controlling uric acid levels in the blood.
• The drug colchicine, derived from the autumn crocus, is one of the oldest known remedies for gout. And a newer injectable form of the drug appears to work quickly and without side effects.

• This condition is very similar to gout but is caused by different types of crystals — in this case, calcium pryophosphate dihydrate crystals, which typically form for no reason.
• Pseudogout is common among older people, affecting about three percent of people in their 60s and as many as half of all people over 90.

• Although the cause of pseudogout is unknown, it may occur in people who have an abnormally high calcium level in the blood, an abnormally high iron level in the tissues, or abnormally low blood levels of magnesium.
• Symptoms vary widely. Some people have attacks of painful arthritis, usually in the knees, wrists or other relatively large joints.
• Other people have lingering, chronic pain and stiffness in joints of the arms and legs, which doctors may confuse with rheumatoid arthritis.
• Pseudogout is diagnosed in the same manner as gout — removing fluid from the joint through a needle.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to reduce pain and inflammation and colchicine may be given intravenously to relieve the inflammation and pain during attacks.