Gout (also called metabolic arthritis) is a disease created by a build up of uric acid. Uric acid (or urate) is an Organic compound of Carbon, Nitrogen, Oxygen and Hydrogen with the formula C5H4N4O3 The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings M00-M99 - Diseases of the Musculoskeletal system and Connective tissue (M00-M25 Arthropathies (M00-M03 Infectious arthropathies The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Mendelian Inheritance in Man project is a Database that catalogues all the known Diseases with a genetic component, and—when possible—links them The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Uric acid (or urate) is an Organic compound of Carbon, Nitrogen, Oxygen and Hydrogen with the formula C5H4N4O3 In this condition, monosodium urate or uric acid crystals are deposited on the articular cartilage of joints, tendons and surrounding tissues due to elevated concentrations of uric acid in the blood stream. In Materials science, a crystal is a Solid in which the constituent Atoms Molecules or Ions are packed in a regularly ordered repeating Cartilage is a type of dense Connective tissue. It is composed of specialized cells called chondrocytes that produce a large amount of extracellular matrix This provokes an inflammatory reaction of these tissues.
Signs and symptoms
, Cartoon by James Gillray
(1799). James Gillray, sometimes spelled Gilray (born August 13, 1757 in Chelsea; died June 1, 1815) was a British
The artist memorably illustrates the excruciating pain and swelling that are symptoms of the disease.
Gout is characterized by excruciating, sudden, unexpected, burning pain, as well as swelling, redness, warmth, and stiffness in the affected joint. This occurs commonly in men in their toes but can appear in other parts of the body and affects women as well. Low-grade fever may also be present. The patient usually suffers from two sources of pain. The crystals inside the joint cause intense pain whenever the affected area is moved. The inflammation of the tissues around the joint also causes the skin to be swollen, tender and sore if it is even slightly touched. For example, a blanket or even the lightest sheet draping over the affected area could cause extreme pain.
Gout usually attacks the big toe (approximately 75 percent of first attacks); however, it also can affect other joints such as the ankle, heel, instep, knee, wrist, elbow, fingers, and spine. The hallux, commonly referred to as the big toe (also as great toe or thumb toe) even though it's not actually the biggest toe on the foot of some In some cases, the condition may appear in the joints of small toes that have become immobile due to impact injury earlier in life, causing poor blood circulation that leads to gout.
Patients with longstanding hyperuricemia (see below) can have uric acid crystal deposits called tophi (singular: tophus) in other tissues such as the helix of the ear. Hyperuricemia ( American English) or hyperuricaemia ( British English) is the presence of high levels of Uric acid in the blood A tophus (Latin "stone" plural tophi) is a deposit of Crystallised monosodium urate in people with longstanding Hyperuricemia A tophus (Latin "stone" plural tophi) is a deposit of Crystallised monosodium urate in people with longstanding Hyperuricemia The prominent rim of the auricula is called the helix. Where the helix turns downward behind a small tubercle is frequently seen the auricular tubercle of Darwin Elevated levels of uric acid in the urine can lead to uric acid crystals precipitating in the kidneys or bladder, forming uric acid kidney stones. The kidneys are complicated organs that have numerous biological roles In Anatomy, the urinary bladder is a hollow muscular, and distensible (or elastic organ that sits on the Pelvic floor in Mammals It is the Kidney stones, also called renal calculi, are solid concretions (crystal aggregations of dissolved minerals in Urine; calculi typically form
A definitive diagnosis of gout is from light microscopy of fluid aspirated from the joints (this test may be difficult to perform) to demonstrate intracellular monosodium urate crystals in synovial fluid polymorphonuclear leukocytes. Diagnosis is the identification by Process of elimination, of the nature of anything Microscopy is the technical field of using microscopes to view samples or objects Not to be confused with Intercellular, meaning "between cells" Synovial fluid is a thick stringy fluid found in the cavities of Synovial joints With its egg-like consistency ("synovial" partially derives from ovum, Granulocytes are a category of White blood cells characterised by The urate crystal is identified by strong negative birefringence under polarised microscopy and its needle-like morphology. Birefringence, or double refraction, is the decomposition of a ray of Light into two rays (the ordinary ray and the extraordinary ray A trained observer does better in distinguishing them from other crystals.
Hyperuricemia is a common feature, although urate levels are not always raised. Hyperuricemia ( American English) or hyperuricaemia ( British English) is the presence of high levels of Uric acid in the blood  Hyperuricemia is defined as a plasma urate (uric acid) level greater than 420 μmol/L (7. Blood plasma is the Liquid component of Blood, in which the Blood cells are suspended 0 mg/dL) in males (or 380 μmol/L in females). However, a high uric acid level does not necessarily mean a person will develop gout. Uric acid (or urate) is an Organic compound of Carbon, Nitrogen, Oxygen and Hydrogen with the formula C5H4N4O3 Urate is within the normal range in up to two-thirds of cases.  If gout is suspected, the serum urate test should be repeated once the attack has subsided. Other blood tests commonly performed are full blood count, electrolytes, renal function, thyroid function tests and erythrocyte sedimentation rate (ESR). A complete blood count ( CBC) also known as full blood count ( FBC) or full blood exam ( FBE) or blood panel, is An electrolyte is any substance containing free Ions that behaves as an electrically conductive medium Renal function, in Nephrology, is an indication of the state of the Kidney and its role in Renal physiology. Thyroid function tests ( TFTs) is a collective term for Blood tests used to check the function of the Thyroid. The erythrocyte sedimentation rate (ESR also called a sedimentation rate, sed rate, or Biernacki Reaction, is the rate at which Red blood cells This helps to exclude other causes of arthritis, most notably septic arthritis, and to investigate any underlying cause for the hyperuricaemia. Arthritis (from Greek arthro-, joint + -itis, inflammation plural arthritides is a group of conditions involving damage to the Joints of the body Septic arthritis is the invasion of a Joint by an Infectious agent which produces Arthritis.
Gout occurs when mono-sodium urate crystals form on the articular cartilage of joints, on tendons, and in the surrounding tissues. Purine metabolism gives rise to uric acid, which is normally excreted in the urine. Many organisms have Metabolic pathways to synthesize and break down Purines Synthesis Purines are biologically synthesized as Nucleotides (bases attached Uric acid is more likely to form into crystals when there is a hyperuricemia, although it is 10 times more common without clinical gout than with it. Hyperuricemia ( American English) or hyperuricaemia ( British English) is the presence of high levels of Uric acid in the blood 
Purines can be generated by the body via breakdown of cells in normal cellular turnover, or can be ingested in purine-rich foods such as seafood. Purine ( 1) is a heterocyclic Aromatic Organic compound, consisting of a Pyrimidine ring fused to an Imidazole ring The kidneys are responsible for approximately two-third of uric acid excretion, with the gut responsible for the rest. It may be possible that defects in the kidney that may be genetically determined are responsible for the predisposition of individuals for developing gout.
There are also different racial propensities to develop gout. Gout is high among the peoples of the Pacific Islands, and the Māori of New Zealand, but rare in the Australian aborigine despite the latter's higher mean concentration of serum uric acid. This article discusses the Māori people of New Zealand For their language see Māori language, and for other meanings see Māori (disambiguation.  In the United States, gout is twice as prevalent in African American males as it is in European-Americans. 
A seasonal link also may exist, with significantly higher incidence of acute gout attacks occurring in the spring. 
Hyperuricemia is considered an aspect of metabolic syndrome, although its prominence has been reduced in recent classifications. Metabolic syndrome is a combination of medical disorders that increase the risk of developing Cardiovascular disease and diabetes. This explains the increased prevalence of gout among obese individuals. Obesity is a condition in which excess Body fat has accumulated to such an extent that health may be negatively affected
Gout is a form of arthritis that affects mostly men between the ages of 50 and 60. The high levels of uric acid in the blood are caused by protein rich foods. Alcohol intake often causes acute attacks of gout and hereditary factors may contribute to the elevation of uric acid. Typically, persons with gout are obese, predisposed to diabetes and hypertension, and at higher risk of heart disease. Gout is more common in affluent societies due to a diet rich in proteins, fat, and alcohol. When it follows as a consequence of other health conditions such as renal failure, it is often regardless of the person's lifestyle. Renal failure or kidney  Lin, et al have statistical evidence linking gout to lead poisoning and lead level in the body is significantly correlated with urate excretion and gout.  It is known that lead sugar was used to sweeten wine, and that chronic lead poisoning is a cause of gout, which condition is then known as saturnine gout, because of its association with alcohol and excess. Lead(II acetate is a Chemical compound, a white crystalline substance with a Sweetish taste Lead poisoning (also known as saturnism, plumbism, or painter's colic) is a medical condition caused by increased levels of the metal Lead in 
Gout also can develop as co-morbidity of other diseases, including polycythaemia, leukaemia, intake of cytotoxics, obesity, diabetes, hypertension, renal disorders, and hemolytic anemia. Polycythemia (or polycythaemia or erythrocytosis) is a condition in which there is a net increase in the total number of Blood cells, primarily Red Leukemia or leukaemia (Greek leukos λευκός, "white" aima αίμα, "blood" is a Cancer of the Blood Cytotoxicity is the quality of being toxic to cells Examples of toxic agents are a Chemical substance, an Immune cell or some types of Venom Obesity is a condition in which excess Body fat has accumulated to such an extent that health may be negatively affected Diabetes mellitus (ˌdaɪəˈbiːtiːz or /ˌdaɪəˈbiːtəs/ /məˈlaɪtəs/ or /ˈmɛlətəs/ often referred to simply as diabetes ( Ancient Greek: grc Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the Blood pressure is chronically elevated The kidneys are complicated organs that have numerous biological roles Hemolytic anemia is Anemia due to Hemolysis, the abnormal breakdown of Red blood cells (RBCs either in the Blood vessels (intravascular hemolysis This form of gout is often called secondary gout. Diuretics (particularly thiazide diuretics) have traditionally been blamed for precipitating attacks of gout, but a Dutch case-control study from 2006 appears to cast doubt on this conclusion. A diuretic is any Drug that elevates the rate of urination ( Diuresis) Thiazide is a term used to describe a type of molecule and a class of Diuretic. 
Gout with tophi on elbow and knee.
The first line of treatment should be pain relief. Once the diagnosis has been confirmed, the drugs of choice are indomethacin, other nonsteroidal anti-inflammatory drugs (NSAIDs), oral glucocorticoids, or intra-articular glucocorticoids administered via a joint injection. Indometacin ( INN Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAID s or NAID s, are drugs with Analgesic, Antipyretic and in higher Glucocorticoids (GC are a class of Steroid hormones characterised by an ability to bind with the glucocorticoid receptor ( GR) and trigger similar effects Glucocorticoids (GC are a class of Steroid hormones characterised by an ability to bind with the glucocorticoid receptor ( GR) and trigger similar effects In Medicine, a joint injection ( intra-articular injection) is a procedure used in the treatment of inflammatory joint conditions, such as Rheumatoid
Colchicine was previously the drug of choice in acute attacks of gout, as it impairs the motility of granulocytes and can prevent the inflammatory phenomena that initiate an attack. Colchicine is a highly poisonous Natural product and Secondary metabolite, originally extracted from plants of the genus Colchicum ( Autumn Granulocytes are a category of White blood cells characterised by Colchicine should be taken within the first 12 hours of the attack and usually relieves the pain within 48 hours, although side effects (gastrointestinal upset such as diarrhea and nausea) can complicate its use. In Medicine, diarrhea, also spelled diarrhoea (see spelling differences) is frequent loose or liquid Bowel movements Acute diarrhea Nausea ( Latin: Nausea, Greek:, " Sea-sickness " also called wamble) is the sensation of unease and discomfort NSAIDs are the preferred form of analgesia for patients with gout.
A randomized controlled trial found similar benefit from nonsteroidal anti-inflammatory drugs and oral glucocorticoids; however, less adverse drug reactions occurred in the glucocorticoids group. A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAID s or NAID s, are drugs with Analgesic, Antipyretic and in higher Glucocorticoids (GC are a class of Steroid hormones characterised by an ability to bind with the glucocorticoid receptor ( GR) and trigger similar effects An adverse drug reaction (abbreviated ADR) or adverse drug event (abbreviated ADE) is an expression that describes the unwanted negative consequences Glucocorticoids (GC are a class of Steroid hormones characterised by an ability to bind with the glucocorticoid receptor ( GR) and trigger similar effects  In the nonsteroidal anti-inflammatory drugs group, each patient initially received diclofenac (75 mg) intramuscularly, indomethacin 50 mg orally, and acetaminophen 1 g orally. Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAID s or NAID s, are drugs with Analgesic, Antipyretic and in higher Diclofenac (marketed as Flector patch, Voltaren, Voltarol, Diclon, Dicloflex Difen, Difene, Cataflam Indometacin ( INN Paracetamol ( INN) (ˌpærəˈsiːtəmɒl -ˈsɛtə- or acetaminophen ( USAN) is a widely-used Analgesic and Antipyretic Medication The patient was received a 5-days of indomethacin (50 mg orally every 8 hours for 2 days, followed by indomethacin 25 mg every 8 hours for 3 days), and acetaminophen 1 g every 6 hours as needed. The glucocorticoids patients received prednisolone 30 mg orally, and acetaminophen 1 g orally. Glucocorticoids (GC are a class of Steroid hormones characterised by an ability to bind with the glucocorticoid receptor ( GR) and trigger similar effects Prednisolone is the active metabolite of Prednisone. Uses It is a Corticosteroid drug with predominantly Glucocorticoid and low Mineralocorticoid The patient was then given prednisolone 30 mg orally once per day for five days.
Before medical help is available, some over-the-counter medications can provide temporary relief from pain and swelling. NSAIDs such as ibuprofen can reduce the pain and inflammation slightly, although aspirin should not be used as it can worsen the condition. Ibuprofen ( INN) (ˌaɪbjuːˈpɹəʊfɛn (from the now outdated nomenclature i so- bu tyl- pro panoic- phen olic acid is a Non-steroidal Aspirin, or acetylsalicylic acid (ASA (əˌsɛtɨlsælɨˌsɪlɨk ˈæsɨd is a Salicylate drug, often used as an Analgesic to relieve This is because aspirin raises plasma uric acid levels even at low doses by inhibiting uric acid secretion in the renal tubules. Aspirin also reduces vasodilatation due to inhibition of prostaglandin PGE2 and PGI2 synthesis in the renal medulla and glomeruli respectively (see mechanism of action of aspirin). A prostaglandin is any member of a group of Lipid compounds that are derived enzymatically from Fatty acids and have important functions in the Animal body The renal medulla is the innermost part of the Kidney. The renal medulla is split up into a number of sections known as the Renal pyramids. A glomerulus is a Capillary tuft surrounded by Bowman's capsule in Nephrons of the vertebrate Kidney. Aspirin causes several different effects in the body mainly the reduction of inflammation, Analgesia (relief of pain Bleeding and the prevention of This may be a contra-indication for the use of aspirin for gout pain as well.
The anti-hemorrhoidal ointment Preparation H can reduce gout-induced skin swelling temporarily. Hemorrhoids ( AmE) haemorrhoids ( BrE) emerods, or piles are varicosities or swelling and Inflammation An ointment is a viscous semisolid preparation used topically on a variety of body surfaces Preparation H is a brand of medications used in the treatment of Hemorrhoids It was originally packaged in a tube like Toothpaste, with a similar consistency Ice may be applied for 20 to 30 minutes several times a day, and a randomized controlled trial found that patients who used ice packs had better relief of pain without side effects. A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare  Since gout is caused by crystals, it has been suggested that keeping very well hydrated and heating the affected joint in hot water (rather than cooling with ice) will promote the dissolution and clearance of the urate crytals. In Materials science, a crystal is a Solid in which the constituent Atoms Molecules or Ions are packed in a regularly ordered repeating Uric acid (or urate) is an Organic compound of Carbon, Nitrogen, Oxygen and Hydrogen with the formula C5H4N4O3  Keeping the affected area elevated above the level of the heart also may help. Professional medical care is needed for long-term management of gout.
Due to swelling around affected joints for prolonged periods, shedding of skin may occur. This is particularly evident when small toes are affected and may promote fungal infection in the web region if dampness occurs, and treatment is similar to that for common athlete's foot. Athlete's foot, also called Tinea Pedis, is a Parasitic fungal infection of the epidermis of the human foot
Some sufferers of gout report an aggravation of the condition in the knees and toes associated with long periods of immobility, such as when sitting at a computer desk for long hours. Sufferers who notice early swelling or early pain may appear to be able to arrest the aggravation when medical treatment is applied before the condition gets worse. Where this is the case, a medically prescribed anti-inflammatory oral treatment taken with food and bed rest may provide relief within 6 to 8 hours. Bed rest is a Doctor's prescription to spend a longer period of time in bed
Another possibility is use of acetazolamide, one of the first diuretics discovered. Acetazolamide, sold under the trade name Diamox, is a Carbonic anhydrase inhibitor that is used to treat Glaucoma, Epileptic seizures Benign This drug inhibits the action of carbonic anhydrase on the proximal convoluted tubules within the kidneys, which effectively inhibits reabsorption of bicarbonate, thus alkalinizing the urine. In Inorganic chemistry, bicarbonate ( IUPAC -recommended nomenclature hydrogencarbonate) is an intermediate form in the Deprotonation After two to three days of usage, the diuretic effects of this drug decline because of increased downstream reabsorption of ions and water by the renal tubules; however, the alkalinization of urine persists, and this basic urine attracts weak acids such as uric acid and cystine into the urine, thus increasing their urinary excretion. 35
Chronic joint changes
For extreme cases of gout, surgery may be necessary to remove large tophi and correct joint deformity.
- Allopurinol is a xanthine-oxidase inhibitor, widely used in the prevention of attacks of gout, and well tolerated. Allopurinol is a drug used primarily to treat conditions arising from excess Uric acid, most notably chronic Gout. It is safe to use in patients with renal impairment and urate stones. 
- Sulfinpyrazone is an uricosuric. Sulfinpyrazone is a Uricosuric medication used to treat Gout. It is less widely used than allupurinol, and must not be used in patients with renal impairment, or a high urate excretion rate. 
- Allopurinol and azathioprine (Imuran) used together present a risk of a potentially fatal drug interaction, a severe risk of allopurinol use which is of importance to transplant patients being treated with azathioprine for immunosuppression. Allopurinol is a drug used primarily to treat conditions arising from excess Uric acid, most notably chronic Gout. Azathioprine is an immunosuppressant used in Organ transplantation Autoimmune disease such as Rheumatoid arthritis and Pemphigus or inflammatory Azathioprine is an immunosuppressant used in Organ transplantation Autoimmune disease such as Rheumatoid arthritis and Pemphigus or inflammatory A drug interaction is a situation in which a substance affects the activity of a drug, i Immunosuppression involves an act that reduces the activation or Efficacy of the Immune system. 
- Febuxostat ((2-[3-cyano-4-isobutoxyphenyl]-4-methylthiazole-5-carboxylic acid) - a non-purine inhibitor of xanthine oxidase seems to be an alternative that is superior to allopurinol at reducing serum urate levels, but not at reducing attacks of gout; it is currently in Phase III trials. Febuxostat ( INN; brand name Adenuric is an inhibitor of Xanthine oxidase for the treatment for Gout. In health care clinical trials are conducted to allow safety and Efficacy data to be collected for new drugs or devices 
- Probenecid, a uricosuric drug that promotes the excretion of uric acid in urine, is also commonly prescribed - often in conjunction with colchicine. Probenecid is a Uricosuric drug primarily used in treating Gout or Hyperuricemia, that increases uric acid removal in the urine Colchicine is a highly poisonous Natural product and Secondary metabolite, originally extracted from plants of the genus Colchicum ( Autumn The drug fenofibrate (which is used in treating hyperlipidemia) also exerts a beneficial uricosuric effect. Fenofibrate is a drug of the Fibrate class Fenofibrate was discovered by Groupe Fournier SA, before it was acquired by Solvay Pharmaceutical in 2005 Hyperlipidemia, hyperlipoproteinemia or dyslipidemia is the presence of raised or abnormal levels of Lipids and/or Lipoproteins in the 
- As arterial hypertension quite often coexists with gout, treating it with losartan, an angiotensin II receptor antagonist, might have an additional beneficial effect on uric acid plasma levels. Losartan ( rINN) (loʊˈsɑrtən is an Angiotensin II receptor antagonist drug used mainly to treat high blood pressure ( Hypertension) Angiotensin II receptor antagonists, also known as angiotensin receptor blockers (ARBs AT1-receptor antagonists or sartans, are a group of This way losartan can offset the negative side-effect of thiazides (a group of diuretics used for high blood pressure) on uric acid metabolism in patients with gout. Thiazide is a term used to describe a type of molecule and a class of Diuretic. A diuretic is any Drug that elevates the rate of urination ( Diuresis) Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the Blood pressure is chronically elevated
- Gout is suspected to be secondary to untreated sleep apnea in some cases, caused by the release of purines as a by-product of the breakdown of oxygen-starved cells. Sleep apnea is a sleep disorder characterized by pauses in Breathing during Sleep. Treatment for apnea can therefore be effective in lessening incidence of acute gout attacks. 
- A 2004 study suggests that animal flesh sources of purine (such as beef and seafood) greatly increase the risk of developing gout. However, high-purine vegetable sources (such as asparagus, cauliflower, spinach, and green peas) did not. Dairy products such as milk and cheese significantly reduced the chances of gout. The study followed over 40000 men over a period of 12 years, in which 1300 cases of gout were reported. 
- PEG-uricase, a polyethylene glycol ("PEG") conjugate of recombinant porcine uricase (urate oxidase), which breaks down the uric acid deposits is being studied in Phase III clinical trials for the treatment of severe, treatment-refractory gout in the United States in 2006. In health care clinical trials are conducted to allow safety and Efficacy data to be collected for new drugs or devices Year 2006 ( MMVI) was a Common year starting on Sunday of the Gregorian calendar. Pipeline
- Sodium bicarbonate (baking soda) is a traditional remedy, thought to work by raising blood pH (lowering blood acidity). Sodium bicarbonate or sodium hydrogen carbonate is the Chemical compound with the formula NaHCO3 pH is the measure of the acidity or alkalinity of a Solution. However, the added sodium may be inappropriate for some people.
- Ethylenediaminetetraacetic acid (EDTA), a chelator of lead, has successfully increased uric acid excretion. EDTA is a widely used abbreviation for the Chemical compound ethylenediaminetetraacetic acid (and many other names see table Chelation is the binding or complexation of a bi- or multidentate Ligand.  This should be an advantageous treatment for those people whose gout was caused by lead poisoning. Care should be taken to increase intake of trace essential elements since chelation often remove these elements also.
- Potassium supplements should be advantageous to treat gout. Potassium (pəˈtæsiəm is a Chemical element. It has the symbol K (kalium from qalīy Atomic number 19 and Atomic mass 39 Gout can be triggered by the same agents that cause potassium losses such as fasting, surgery, and potassium losing diuretics.  A potassium deficiency can increase urate levels in the blood. 
- Research from the University of British Columbia suggests long-term coffee consumption is associated with a lower risk of gout. The University of British Columbia ( UBC) is a Canadian public research University with campuses near Vancouver and in Kelowna Other studies extend this benefit to tea and other caffeinated foods and drinks. 
See Saag and Choi, 2006, an open-access review article, for detailed references and further information. 
The serum level of uric acid is the primary risk factor for gout. The serum level is the result of both intake (diet) and output (excretion). Diet should be low fat and low protein.
Reduce intake of purines
The solubility threshold for uric acid is approximately 6. 7 mg/dl; above this threshold crystals may form. Healthy subjects in the Normative Aging Study who had serum levels of uric acid over 9. 0 mg/dl suffered a 22% incidence of gout over six years, compared to less than one percent for those with 7. 0-8. 9 mg/dl. The average uric acid level in men is 5. 0 mg/dl, and substitution of a purine-free formula diet reduces this to 3. 0 mg/dl. A purine-restricted diet lowers the level nearly as much (1-2 mg/dl).
A diet low in purines reduces the serum level of uric acid, unless these levels are caused by other health conditions and not as responsive to dietary changes. For notable sources of dietary purines, see "Foods to avoid" section below.
Protein is a crude proxy for purines; a more precise proxy is muscle. Apart from the notable dietary purines above, the main source of dietary purines is DNA and RNA, via their bases adenine and guanine. Deoxyribonucleic acid ( DNA) is a Nucleic acid that contains the genetic instructions used in the development and functioning of all known Ribonucleic acid ( RNA) is a Nucleic acid that consists of a long chain of Nucleotide units Adenine is a Purine with a variety of roles in Biochemistry including Cellular respiration, in the form of both the energy-rich Adenosine Guanine is one of the five main Nucleobases found in the Nucleic acids DNA and RNA, the others being Adenine, Cytosine, All sources of dietary protein supply some purines, but some sources provide far more purines than others. Meat (particularly dark meat) and seafood are high in purine because muscle cells are packed with mitochondria, which have their own DNA and RNA. Muscle (from Latin musculus, diminutive of mus "mouse" is contractile tissue of the body and is derived from the In Cell biology, a mitochondrion (plural mitochondria) is a membrane-enclosed Organelle found in most eukaryotic cells. In a large prospective study, high consumption of meat and seafood were found associated with an elevated risk of gout onset (41% and 50%, respectively). High consumption of dairy products, high in protein but very low in DNA and RNA, was associated with a 44% decrease in the incidence of gout. Consumption of the more purine-rich vegetables or a high protein diet per se had no significant correlation.
Men who consume two or more sugary soft drinks a day have an 85% higher risk of gout compared with those who drink less than one a month.  This is because soft drinks contain large quantities of high-fructose corn syrup (HFCS) (read label on any soft drink), which results in Hyperuricemia in blood. High-fructose corn syrup (HFCS is any of a group of Corn syrups that has undergone Enzymatic processing to increase its Fructose content and is then mixed Hyperuricemia ( American English) or hyperuricaemia ( British English) is the presence of high levels of Uric acid in the blood  Hyperuricemia, in turn predispose the body for gout. 
Consumption of beer is associated with a 49% increase in relative risk per daily 12-oz serving. By contrast, consumption of spirits was associated with only a 15% increase in relative risk, and no association at all was found with consumption of wine.
Some medical drugs are purine-based. Notable among these are the purine-analog antimetabolite drugs, sometimes used as chemotherapy agents. An antimetabolite is a chemical with a similar structure to a substance (a Metabolite) required for normal biochemical reactions yet different enough to interfere with the normal Chemotherapy, in its most general sense refers to treatment of disease by chemicals that kill cells specifically those of micro-organisms or Cancer.
Increase output of uric acid
As mentioned above, medicines to induce uric acid output are called uricosuric drugs. Uricosuric Medications ( Drugs are substances that increase the excretion of Uric acid in the Urine, thus reducing uric acid concentrations in Two such drugs are Probenecid and Sulfinpyrazone. Probenecid is a Uricosuric drug primarily used in treating Gout or Hyperuricemia, that increases uric acid removal in the urine Sulfinpyrazone is a Uricosuric medication used to treat Gout.
Additional dietary recommendations can be made which reduce gout indirectly, hypertension, cardiovascular disease, diabetes, and metabolic syndrome. Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the Blood pressure is chronically elevated Cardiovascular disease or cardiovascular diseases refers to the class of diseases that involve the Heart or Blood vessels ( arteries and Diabetes mellitus (ˌdaɪəˈbiːtiːz or /ˌdaɪəˈbiːtəs/ /məˈlaɪtəs/ or /ˈmɛlətəs/ often referred to simply as diabetes ( Ancient Greek: grc Metabolic syndrome is a combination of medical disorders that increase the risk of developing Cardiovascular disease and diabetes.
The following suggestions do not meet with universal approval among medical practitioners.
Low purine diet:
- To lower uric acid:
- bing cherries were reported to reduce uric acid in a small study. Purine ( 1) is a heterocyclic Aromatic Organic compound, consisting of a Pyrimidine ring fused to an Imidazole ring Bing is a Cultivar of Cherry that originated in the Pacific Northwest, specifically in what is now Milwaukie, Oregon. 
- celery extracts (celery or celery seed either in capsule form or as a tisane/infusion) is believed by many to reduce uric acid levels (although these are also diuretics). See also Wild celery Apium graveolens is a plant species in the family Apiaceae, and yielding celery and Celeriac A diuretic is any Drug that elevates the rate of urination ( Diuresis) Celery extracts have been reported to act synergistically with anti-inflammatory drugs. 
- Cheese has been recommended as a low-purine food, and dairy products have been found to reduce the risk of gout.
- Carbonated beverages and sugar have also been recommended as a low-purine food,  even though it was established that men who consume two or more sugary soft drinks a day have an 85% higher risk of gout compared with those who drink less than one a month. 
- Dietary supplements Quercetin, a flavonoid, can decrease uric acid levels. Quercetin is a Flavonoid and to be more specific a flavonol. It is the Aglycone form of a number of other flavonoid Glycosides, such as The term flavonoid (or bioflavonoid refers to a class of Plant Secondary metabolites According to the IUPAC nomenclature they can be classified into Quercetin can be taken with bromelain to improve its absorption. Bromelain can refer to one of two Protease Enzymes extracted from the plant family Bromeliaceae, or it can refer to a combination of those enzymes along In addition, Pantothenic acid (vitamin B5) is said to help with the excretion process of uric acid. Pantothenic acid, also called Vitamin B5 (a B vitamin) is a water- Soluble vitamin required to sustain life ( 
- Food to avoid:
- foods high in purines
- limit food high in protein such as meat, fish, poultry, or tofu to 8 ounces (226 grams) a day. Purine ( 1) is a heterocyclic Aromatic Organic compound, consisting of a Pyrimidine ring fused to an Imidazole ring In modern English usage meat most often refers to Animal tissue used as food mostly Skeletal muscle and associated Fat, but it may also refer Fish are aquatic Vertebrate animals that are typically ectothermic (previously Cold-blooded) covered with scales, and equipped with two Poultry is the category of Domesticated Birds which some humans keep for the purpose of collecting their eggs, or kill for their Meat and/or Tofu, also (the Japanese Romaji spelling doufu (the Chinese Pinyin spelling often used in Chinese recipes or bean curd (the literal Avoid entirely during a flare up. Tofu has been proposed as a safe source of protein for gout patients due to its small and transient effect on plasma urate levels. 
- sweetbreads, kidneys, liver, brains, or other offal meats. Sweetbreads are the thymus glands of lamb, Beef, or Pork. There are two different connected Glands one set in the neck and the The kidneys are complicated organs that have numerous biological roles The liver is a vital organ in the human body and is present in Vertebrates and some other animals The brain is the center of the Nervous system in animals All Vertebrates and the majority of Invertebrates have a brain Offal is the Entrails and Internal organs of a Butchered Animal. 
- sardines and anchovies
- seafood particularly shellfish such as clam, oyster, scallop, shrimp, crab, lobster, and crayfish. For the hide and seek-like game see Hide and seek. Sardines, or pilchards, are a group of several types of small Oily The anchovies are a family ( Engraulidae) of small common salt-water fish Seafood is any Sea Animal or Seaweed that is served as Food, or is suitable for eating particularly saltwater animals such
- Asparagus. Cauliflower. Mushrooms. Spinach. (Even though above says "Consumption of the more purine-rich vegetables or a high protein diet per se had no significant correlation. ")
- Dry beans (lentils & peas).
- alcohol. In Chemistry, an alcohol is any Organic compound in which a Hydroxyl group ( - O[[hydrogen H]]) is bound to a Carbon  Some claim that this applies especially to beer (high in guanosine), on the basis that brewer's yeasts are very rich in purine. Beer is the world's oldest and most widely consumed Alcoholic beverage and the third most popular drink overall after water and tea Guanosine is a Nucleoside comprising Guanine attached to a Ribose ( Ribofuranose) ring via a β-N9- Glycosidic bond. Since most modern commercial beer contains only trace amounts of yeast, this claim requires further substantiation. Formerly, port wine was sweetened with litharge, causing lead poisoning, of which gout is a complication. Port wine (also known as Vinho do Porto, Oporto, Porto, and often simply Port) is a Portuguese, Fortified Litharge is one of the natural mineral forms of Lead(II oxide, PbO Lead poisoning (also known as saturnism, plumbism, or painter's colic) is a medical condition caused by increased levels of the metal Lead in Ironically, red wines, particularly those produced by traditional methods, contain procyanidins released from grape seeds during wine making, which have been reported to lower serum uric acid levels by an indirect mechanism. Proanthocyanidin (also known as procyanidin oligomeric proanthocyanidin ( OPC) pycnogenol, leukocyanidin and leucoanthocyanin Winemaking, or vinification, is the production of Wine, starting with selection of the Grapes and ending with bottling the finished wine  However, withdrawal of urate-lowering therapy is associated with recurrence of acute gouty arthritis. 
- meat extracts, consommés, and gravies
- Foods high in fructose, as discussed above, especially high-fructose corn syrup (HFCS) as main ingredient (READ LABEL). In Cooking, a consommé is a type of clear soup made from richly flavored stock or bouillon that has been clarified usually through a fining process involving Gravy is an English Sauce made often from the juices that run naturally from meat or vegetables during cooking Fructose (also levulose or laevulose) is a simple reducing Sugar ( Monosaccharide) found in many foods and is one of the three High-fructose corn syrup (HFCS is any of a group of Corn syrups that has undergone Enzymatic processing to increase its Fructose content and is then mixed 
- To avoid dehydration:
- Drink plenty of liquids, especially water, to dilute and assist excretion of urates;
- Avoid diuretic foods or medicines like aspirin(aspirin should be avoided by those suffering from gout, unless specified by a qualified physician), vitamin C, tea and alcohol. Soft drink is a beverage that does not contain Alcohol. Carbonated soft drinks are commonly known as soda soda pop pop, or In Cooking, a syrup (from Arabic' ar شراب sharab, beverage via Latin siropus) is a thick Viscous Liquid Candy, specifically sugar candy, is a confection made from a concentrated solution of sugar in water to which a variety of flavorings and colorants is added Ice cream or ice-cream (originally iced cream) is a frozen dessert made from Dairy products such as Milk and Cream, combined Cake is a form of Food that is usually sweet and often baked. In the United States and Canada, a cookie is a small flat-baked treat usually round containing milk flour eggs and sugar etc Dehydration ( hypohydration) is the removal of Water ( hydro in ancient Greek) from an object Water is a common Chemical substance that is essential for the survival of all known forms of Life. A diuretic is any Drug that elevates the rate of urination ( Diuresis) Aspirin, or acetylsalicylic acid (ASA (əˌsɛtɨlsælɨˌsɪlɨk ˈæsɨd is a Salicylate drug, often used as an Analgesic to relieve Vitamin C or L-ascorbate is an Essential nutrient for a large number of higher primate species a small number of other Mammalian Tea refers to the cured agricultural product of the leaves leaf buds and internodes of Camellia sinensis, which have been prepared and cured for the market The role of diuretics in triggering gout has been disputed. 
- Moderate intake of purine-rich vegetables is not associated with increased gout. 
Writing ca. 30 AD, Aulus Cornelius Celsus appeared to recognize many of the features of gout, including its link with a urinary solute, late onset in women, linkage with alcohol, and perhaps even prevention by dairy products. Aulus Cornelius Celsus (ca 25 BC—ca 50 was a Roman encyclopedist and Physician.  "Again thick urine, the sediment from which is white, indicates that pain and disease are to be apprehended in the region of joints or viscera. " and "Joint troubles in the hands and feet are very frequent and persistent, such as occur in cases of podagra and cheiragra. These seldom attack eunuchs or boys before coition with a woman, or women except those in whom the menses have become suppressed. Upon the commencement of pain blood should be let; for when this is carried out at once in the first stages it ensures health, often for a year, sometimes for always. Some also, when they have washed themselves out by drinking asses' milk, evade this disease in perpetuity; some have obtained lifelong security by refraining from wine, mead and venery for a whole year; indeed this course should be adopted especially after the primary attack, even although it has subsided. "
The Roman gladiatorial surgeon Galen described gout as a discharge of the four humors of the body in unbalanced amounts into the joints. Ancient Rome was a Civilization that grew out of a small agricultural community founded on the Italian Peninsula as early as the 10th century BC Galen ( Greek: Γαληνός Galēnos; Latin: Claudius Galenus, Aelius Galenus, Claudius Aelius Galenus, or Erich Adickes, Eduard Spränger, Ernst Kretschmer, and Erich Fromm all theorized on the four temperaments (with different names and greatly The Latin term for a drop, as a drop of discharge, is gutta -- the term gout descends from this word. Latin ( lingua Latīna, laˈtiːna is an Italic language, historically spoken in Latium and Ancient Rome.
Notable sufferers of gout have included:
Royalty and nobility
Government and politics
Military and navy
Fine and performing arts
- Roe Conn
- Bobby Hill
- Harry Judd
- Jared Leto
- Sir Laurence Olivier
- Peter Paul Rubens
- George Lopez
- Dr. Anne (6 February 1665 – 1 August 1714 became Queen of England, Scotland and Ireland on 8 March 1702 succeeding William III of England and II of Charles IV ( Czech: Karel IV, German: Karl IV, Hungarian: IV Károly; 14 May 1316 &ndash Charles V (24 February 1500 &ndash 21 September 1558 was Frederick II (Friedrich II January 24 1712 August 17 1786) was a King of Prussia (1740&ndash1786 from the Henry VIII (28 June 1491 &ndash 28 January 1547 was King of England and Lord of Ireland, later King of Ireland and claimant to the Kingdom of Napoléon III, also known as Louis-Napoléon Bonaparte (full name Charles Louis Napoléon Bonaparte) (20 April 1808 9 January 1873 was the first President Christopher Columbus (1451 &ndash May 20 1506 was an Italian Navigator, colonizer Benjamin Disraeli 1st Earl of Beaconsfield, KG, PC, FRS (born Benjamin D'Israeli; 21 December 1804 &ndash 19 April 1881 was Benjamin Franklin ( April 17 1790 was one of the Founding Fathers of the United States of America. John Hancock ( October 8 1793 was a Massachusetts merchant and prominent patriot of the American Revolution. Thomas Jefferson (April 13 1743 – July 4 1826 was the third President of the United States (1801–1809 the principal author of the Declaration of Independence George Mason IV ( December 11, 1725 &ndash October 7, 1792) was a United States patriot, statesman and delegate from Jeff Mullis is a State senator of the Republican Party representing the 53rd district in the Georgia State Senate. William Pitt 1st Earl of Chatham PC (15 November 1708 &ndash 11 May 1778 was a British Whig Statesman who achieved his greatest fame as Early years Kublai Khan studied Chinese culture and became enamoured of it Lennart Torstenson, Count of Ortala, Baron of Virestad ( 17 August 1603 – 7 April 1651) was Anthony Wayne (January 1 1745–December 15 1796 was a United States Army general and statesman Roe B Conn (born in Chicago on 6 June 1964) is an American radio Talk show host who is the host of The Roe Conn Show which Robert Jeffrey "Bobby" Hill is a character on the animated series King of the Hill and is voiced by Pamela Adlon (sometimes as Pamela Segall Harry Mark Christopher Judd, (born December 23, 1985 in Chelmsford, Essex, England Jared Joseph Leto (born December 26, 1971) is an American Actor and Musician. Laurence Kerr Olivier Baron George Lopez (born April 23, 1961) is a Mexican American Comedian and Actor. Jerell Chua
- Johnny Vegas
- Maurice Cheeks
- Harald Morten Evensen, a. Johnny Vegas (born 11 September, 1971 as Michael Joseph Pennington) is an English Actor and Comedian. Maurice "Mo" Edward Cheeks (born September 8 1956 in Chicago Illinois) is a retired American professional Basketball player k. a. Sid Psoriasis
Science and mathematics
- Pseudogout is a very similar disease, but caused by deposition of calcium pyrophosphate, not uric acid. William Wilkie Collins ( 8 January 1824 &ndash 23 September 1889) was an English Novelist, Playwright, and Joseph Conrad (born Józef Teodor Konrad Korzeniowski, 3 December 1857 – 3 August 1924 was a Polish-born English novelist Henry Fielding ( April 22, 1707 &ndash October 8, 1754) was an English Novelist and Dramatist known for his Henry James, OM ( –) son of theologian Henry James Sr, brother of the philosopher and psychologist William James and diarist Alice James Samuel Johnson (often referred to as Dr Johnson) (18 September John Milton ( 9 December, 1608 – 8 November, 1674) was an English Poet, Prose Polemicist and Pablo Neruda ( July 12, 1904 – September 23, 1973) was the pen name and later legal name of the Chilean writer and politician Sir Francis Osbert Sacheverell Sitwell 5th Baronet, ( December 6, 1892 &ndash May 4, 1969) was an English writer Alfred Tennyson 1st Baron Tennyson (6 August 1809 – 6 October 1892 was Poet Laureate of the United Kingdom and remains one of the most popular English poets Charles Robert Darwin (February 12 1809 &ndash April 19 1882 was an English naturalist, who realised and demonstrated that all Species of life Sir Isaac Newton, FRS (ˈnjuːtən 4 January 1643 31 March 1727) Biography Early years See also Isaac Newton's early life and achievements Kirk Wesley Rueter (born December 1, 1970 in Centralia Illinois) is a retired Left-handed Pitcher in Major League Baseball Scott Anthony Levy (born September 8 1964 in Philadelphia, Pennsylvania) better known by his Ring name Raven, is an American Professional Donald Arvid Nelson (born May 15 1940 in Muskegon Michigan) is a former NBA player and currently is a National Basketball Association Head David Lee Wells (born May 20, 1963 in Torrance California) is a former Major League Baseball Starting pitcher. Curtis Montague Schilling (born November 14 1966 in) is an American Major League Baseball Pitcher. Maurice "Mo" Edward Cheeks (born September 8 1956 in Chicago Illinois) is a retired American professional Basketball player John Feinstein is an American sportswriter and Commentator. He is a columnist for Chapin Times the Washington Post, an Author, is Michel de Nostredame (14 December 1503 or 21 December 1503 &ndash 2 July 1566 usually Latinized to Nostradamus, was a French Apothecary Guy Ernest Debord ( December 28, 1931 - November 30, 1994) was a Marxist theorist French writer Filmmaker, hypergraphist John Calvin (or Jean Calvin) (10 July 1509 – 27 May 1564 was a French Protestant theologian during the Protestant Reformation and Not to be confused with Antipope Clement VIII. Pope Clement VIII ( February 24, 1536 &ndash March 3, 1605 Rev Peter John Gomes is an American preacher and theologian at Harvard University 's Divinity School. Charles Haddon Spurgeon, commonly CH Spurgeon, ( June 19, 1834 &ndash January 31, 1892) was a British Reformed Calcium pyrophosphate deposition disease ( CPPD) is a rheumatologic disorder with varied clinical manifestations due to precipitation of Calcium pyrophosphate Calcium pyrophosphate (Ca2O7P2 is a chemical compound that can be formed by the reaction of Pyrophosphoric acid and a calcium base or by
- ^ Sturrock R (2000). "Gout. Easy to misdiagnose". BMJ 320 (7228): 132–3. PMID 10634714.
- ^ Siva C, Velazquez C, Mody A, Brasington R (2003). "Diagnosing acute monoarthritis in adults: a practical approach for the family physician". Am Fam Pghysician 68 (1): 83–90. PMID 12887114.
- ^ Virsaladze D, Tetradze L, Djavashvili L, Esakia N, Tananashvili D. (2007). "Levels of uric Acid in serum in patients with metabolic sypfoirefudvhfduyvcjvhfgndrome. ". Georgian Med News 146: 34–7. PMID 17595458.
- ^ Roberts-Thomson R, Roberts-Thomson P (1999). "Rheumatic disease and the Australian aborigine". Ann Rheum Dis 58 (5): 266&ndasgh;70. PMID 10225809.
- ^ Rheumatology Therapeutics Medical Center. What Are the Risk Factors for Gout?. Retrieved on 2007-01-26. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 1340 - King Edward III of England is declared King of France.
- ^ Schlesinger N, Gowin KM, Baker DG, Beutler AM, Hoffman BI, Schumacher HR Jr. . Acute gouty arthritis is seasonal.. Retrieved on 2007-09-27. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 489 - Odoacer attacks Theodoric at the Battle of Verona and is defeated again
- ^ Gallerani M, Govoni M, Mucinelli M, Bigoni M, Trotta F, Manfredini R. . Seasonal variation in the onset of acute microcrystalline arthritis.. Retrieved on 2007-09-27. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 489 - Odoacer attacks Theodoric at the Battle of Verona and is defeated again
- ^ Robert S. Ivker, D. O. , et al (1999). The Complete Self-Care guide to Holistic Medicine, 186–8. ISBN 0874779863.
- ^ Lin JL, Tan DT, Ho HH, Yu CC 2002 Environmental lead exposure and urate excretion in the general population. Am J Med. 2002 Nov;113(7):563-8.
- ^ Wright, LF; Saylor, RP; Ceere, FA (1984) Occult lead intoxication in patients with gout and kidney disease. Journal of Rheumatology. 11, no. 4; 517-520.
- ^ Lin JL, Huang PT. (1994). "Body lead stores and urate excretion in men with chronic renal disease". J Rheumatol 21 (4): 705–9. PMID 8035397.
- ^ Shadick NA, Kim R, Weiss S, Liang MH, Sparrow D, Hu H. (2000). "Effect of low level lead exposure on hyperuricemia and gout among middle aged and elderly men: the Normative Aging Study". J Rheumatol 27 (7): 1708–12. PMID 10914856.
- ^ Ball GV. (1971). "Two epidemics of gout". Bull Hist Med 45 (5): 401–8. PMID 4947583.
- ^ Janssens H, van de Lisdonk E, Janssen M, van den Hoogen H, Verbeek A (2006). "Gout, not induced by diuretics? A case-control study from primary care". Ann Rheum Dis 65 (8): 1080–3. doi:10.1136/ard.2005.040360. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 16291814.
- ^ Janssens HJEM, Janssen M, van de Lisdonk EH, van Riel PLCM, van Weel C (2008). "Use of oral prednisolone or naproxen for the treatment of gout arthritis: a double-blind, randomised equivalence trial". Lancet 371 (9627): 1854–1860. doi:10.1016/S0140-6736(08)60799-0. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document.
- ^ Man CY, Cheung IT, Cameron PA, Rainer TH (2007). "Comparison of oral prednisolone/paracetamol and oral indomethacin/paracetamol combination therapy in the treatment of acute goutlike arthritis: a double-blind, randomized, controlled trial". Annals of emergency medicine 49 (5): 670–7. doi:10.1016/j.annemergmed.2006.11.014. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 17276548.
- ^ Schlesinger N, Detry MA, Holland BK, et al (2002). "Local ice therapy during bouts of acute gouty arthritis". J. Rheumatol. 29 (2): 331–4. PMID 11838852.
- ^ rapid response from a GP to BMJ. com. http://www.bmj.com/cgi/eletters/332/7553/1315#135610
- ^ The British National Formulary website, www. bnf. org
- ^ Underwood, M. Diagnosis and management of gout. BMJ 2006;332:1315-1319
- ^ Becker M, Schumacher H, Wortmann R, MacDonald P, Eustace D, Palo W, Streit J, Joseph-Ridge N (2005). "Febuxostat compared with allopurinol in patients with hyperuricemia and gout". N Engl J Med 353 (23): 2450–61. doi:10.1056/NEJMoa050373. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 16339094.
- ^ Bardin T (2003). "Fenofibrate and losartan". Ann Rheum Dis 62 (6): 497–8. doi:10.1136/ard.62.6.497. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 12759281.
- ^ Abrams B (2005). "Gout is an indicator of sleep apnea". Sleep 28 (2): 275. PMID 16171252.
- ^ a b Choi H, Atkinson K, Karlson E, Willett W, Curhan G (2004). "Purine-rich foods, dairy and protein intake, and the risk of gout in men" (PDF). N Engl J Med 350 (11): 1093–103. doi:10.1056/NEJMoa035700. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 15014182.
- ^ The British Pharmaceutical Codex. Published by direction of the Council of the Pharmaceutical Society of Great Britain, 1911. Sodium
- ^ Lin JL, Yu CC, Lin-Tan DT, Ho HH 2001 Lead chelation therapy and urate excretion in patients with chronic renal diseases and gout. Kidney Int. Jul;60(1):266-71.
- ^ Rodman JS 2002 Intermittent versus continuous alkaline therapy for uric acid stones and uretal stones of uncertain composition. Urology 60; 378-382.
- ^ Davis WH 1970 Does potassium deficiency hold a clue to metabolic disorders associated with liability to heart disease?. South African Med. Journal 44; 1297.
- ^ Hyon K. Choi, Walter Willett, Gary Curhan (2007). "Coffee consumption and risk of incident gout in men: A prospective study". Arthritis & Rheumatism 56 (6): 2049–2055. PMID 17530645.
- ^ Choi HK, Curhan G. (2007). "Coffee, tea, and caffeine consumption and serum uric acid level: The third national health and nutrition examination survey". Arthritis & Rheumatism 57 (5): 816–821. doi:10.1002/art.22762. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 17530681.
- ^ Saag KG, Choi H (2006). "Epidemiology, risk factors, and lifestyle modifications for gout". Arthritis Res. Ther. 8 Suppl 1: S2. doi:10.1186/ar1907. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 16820041.
- ^ Nakagawa T, Hu H, Zharikov S, et al (2006). "A causal role for uric acid in fructose-induced metabolic syndrome". Am. J. Physiol. Renal Physiol. 290 (3): F625-31. doi:10.1152/ajprenal.00140.2005. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 16234313.
- ^ Mayes PA (1993). "Intermediary metabolism of fructose". Am. J. Clin. Nutr. 58 (5 Suppl): 754S-765S. PMID 8213607.
- ^ a b Johnson, Richard Joseph; Timothy Gower (2008). The Sugar Fix : The High-Fructose Fallout That is Making You Fat and Sick. US: Rodale, 304. ISBN 10 1-59486-665-1.
- ^ Jacob RA, Spinozzi GM, Simon VA, et al (2003). "Consumption of cherries lowers plasma urate in healthy women". J. Nutr. 133 (6): 1826-9. PMID 12771324.
- ^ BLAU LW (1950). "Cherry diet control for gout and arthritis". Tex. Rep. Biol. Med. 8 (3): 309-11. PMID 14776685.
- ^ Whitehouse MW, Butters DE (2003). "Combination anti-inflammatory therapy: synergism in rats of NSAIDs/corticosteroids with some herbal/animal products". Inflammopharmacology 11 (4): 453-64. doi:10.1163/156856003322699636. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 15035799.
- ^ Harris MD, Siegel LB, Alloway JA (1999). "Gout and hyperuricemia". American family physician 59 (4): 925-34. PMID 10068714.
- ^ Harris MD, Siegel LB, Alloway JA (1999). "Gout and hyperuricemia". American family physician 59 (4): 925-34. PMID 10068714.
- ^ "Gout" by Zina Kroner, D.O. ,
- ^ Yamakita J, Yamamoto T, Moriwaki Y, Takahashi S, Tsutsumi Z, Higashino K (1998). "Effect of Tofu (bean curd) ingestion and on uric acid metabolism in healthy and gouty subjects". Adv. Exp. Med. Biol. 431: 839-42. PMID 9598181.
- ^ Robinson CH (1954). "The low purine diet". Am. J. Clin. Nutr. 2 (4): 276-7. PMID 13188851.
- ^ Chou P, Soong LN, Lin HY (1993). "Community-based epidemiological study on hyperuricemia in Pu-Li, Taiwan". J. Formos. Med. Assoc. 92 (7): 597-602. PMID 7904493.
- ^ Robinson CH (1954). "The low purine diet". Am. J. Clin. Nutr. 2 (4): 276-7. PMID 13188851.
- ^ Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G (2004). "Purine-rich foods, dairy and protein intake, and the risk of gout in men". N. Engl. J. Med. 350 (11): 1093-103. doi:10.1056/NEJMoa035700. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 15014182.
- ^ Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G (2004). "Alcohol intake and risk of incident gout in men: a prospective study". Lancet 363 (9417): 1277-81. doi:10.1016/S0140-6736(04)16000-5. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 15094272.
- ^ Corder R, Mullen W, Khan NQ, et al (2006). "Oenology: red wine procyanidins and vascular health". Nature 444 (7119): 566. doi:10.1038/444566a. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 17136085.
- ^ Wang Y, Zhu JX, Kong LD, Yang C, Cheng CH, Zhang X (2004). "Administration of procyanidins from grape seeds reduces serum uric acid levels and decreases hepatic xanthine dehydrogenase/oxidase activities in oxonate-treated mice". Basic Clin. Pharmacol. Toxicol. 94 (5): 232-7. doi:10.1111/j.1742-7843.2004.pto940506.x. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 15125693.
- ^ Perez-Ruiz F, Atxotegi J, Hernando I, Calabozo M, Nolla JM (2006). "Using serum urate levels to determine the period free of gouty symptoms after withdrawal of long-term urate-lowering therapy: a prospective study". Arthritis Rheum. 55 (5): 786-90. doi:10.1002/art.22232. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 17013833.
- ^ Robinson CH (1954). "The low purine diet". Am. J. Clin. Nutr. 2 (4): 276-7. PMID 13188851.
- ^ Janssens HJ, van de Lisdonk EH, Janssen M, van den Hoogen HJ, Verbeek AL (2006). "Gout, not induced by diuretics? A case-control study from primary care". Ann. Rheum. Dis. 65 (8): 1080-3. doi:10.1136/ard.2005.040360. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 16291814.
- ^ Ordi J, Alonso P, de Zulueta J et al. (2006). "The severe gout of Holy Roman Emperor Charles V". N Engl J Med 355 (5): 516–20. doi:10.1056/NEJMon060780. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 16885558.
35. ) Katzung, Bertram G. Basic and Clinical Pharmacology, 10th edition. New York: McGraw Hill Medical, 2007. pp. 242
© 2009 citizendia.org; parts available under the terms of GNU Free Documentation License, from http://en.wikipedia.org
- (pathology, not countable) An extremely painful inflammation of joints, especially of the big toe, caused by a metabolic defect resulting in the accumulation of uric acid in the blood and the deposition of urates around the joints.
- a spurt or splotch (usually followed by the preposition of)
network: | |