Regarded as a “disease of kings” for its association with a diet rich in meats and alcohol, gout has become a more plebeian disorder. The number of Americans with gout is rising as the population ages, becomes heavier and is exposed to foods and other substances that can precipitate the disorder , which is also increasing globally.

Historically a male disease, gout has been rising in older women, who until menopause are protected by estrogen.

Gout is caused by a high blood level of uric acid that forms irritating urate crystals that lodge in joints or soft tissues, causing intense pain. Uric acid is produced when the body metabolizes purines, common components of many foods, especially organ meats, anchovies, herring, asparagus and mushrooms. Excessive consumption of alcohol and possibly drinks containing fructose are also implicated.

Elevated levels of uric acid can result either from the body’s overproduction of the substance or from an inability of the kidneys to excrete it adequately.

Dr. Tuhina Neogi, a rheumatologist at Boston University School of Medicine, explained that humans lack the enzyme uricase, and thus are unable to convert urate into allantoin, the end-product of purine metabolism.

Among the medications linked to an increased risk of developing gout are thiazide diuretics, used to treat high blood pressure; cyclosporine, an immunosuppressant drug used to prevent organ rejection in transplant patients; and low-dose aspirin . ( High doses protect against gout by increasing uric acid excretion, Dr. Neogi wrote.)

Even drugs used to lower uric acid long-term can initially provoke an attack of gout , she said.

The risk of gout is also higher among people with disorders that are common in modern society, including hypertension, diabetes, high cholesterol, atherosclerosis and congestive heart failure, obesity and the so-called metabolic syndrome, which includes insulin resistance.

A family history of gout is a risk factor . Several genes have been linked to the disease.

Dr. Neogi said people vary in their response to uric acid. High blood levels are not always present during an attack of gout, she said, and some people with high levels never develop it.

Although symptoms are usually quite characteristic - rapid development of severe pain, redness and swelling, most often in the big toe - a more certain diagnosis requires detection of urate crystals in an inflamed joint.

If gout is untreated, deposits of urate crystals may form into nodules called tophi beneath the skin. Tophi can become swollen and tender during flare-ups of gout. Urate deposits may also cause kidney stones.

Treatment begins with dietary changes , avoiding organ meats and limiting poultry and seafood. Better to rely more on low-fat dairy, eggs and vegetarian sources of protein.

Routine high intake of coffee (and perhaps also tea) can lower uric acid levels. Cherry juice may be protective.

Drinking lots of water will limit the buildup of urate . Alcohol should be avoided.

Hefty doses of ibuprofen will reduce the pain and inflammation . A doctor might prescribe colchicine . Unfortunately, it can cause nausea, vomiting and diarrhea. A corticosteroid like prednisone may be taken to reduce pain and inflammation.

Frequent attacks may require continuing treatment with urate-lowering drugs called xanthine oxidase inhibitors, which reduce uric acid. Another drug, probenecid, helps the kidneys excrete uric acid.


JANE E. BRODY