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Gout is a chronic metabolic disease which is frequently encountered in primary care and hospital practice settings.1 Although awareness of this condition dates back many years, the understanding of gout has improved significantly, and a correlation has been established between the risk of developing gout and maintaining a diet high in red meats or seafood.2 Men are at a substantially higher risk, with diagnosis occurring about seven to nine times more often in men compared to women.3 Serum uric acid (SUA) measurement remains an important assessment parameter for gout. SUA concentrations tend to be higher with increasing age, blood pressure, body weight, and alcohol intake.4 However, gout flares can occur in individuals with normal SUA levels, while many patients with elevated SUA concentrations do not develop gout.

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Gouty arthritis is the most common inflammatory arthritis in men over age 40.5 In the United States, an estimated 6.1 million adults have experienced an acute flare of gout.6 Recently, a renewed interest has highlighted the potential implications of this disease, including the relationship to common comorbidities such as obesity, type 2 diabetes, dyslipidemia, hypertension, and heart disease.7 The economic burden of this increasingly prevalent condition is substantial, with new gout cases in the United States costing an estimated 27 million dollars annually.8

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Pathophysiology

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Gout is characterized by acute and often recurrent arthritis mediated by the formation of monosodium urate (MSU) crystals within the joints and surrounding tissues, resulting in pain, erythema, and inflammation. Hyperuricemia, or elevated SUA concentrations, can be a result of various causes, including a defect in purine metabolism, a decrease in uric acid excretion, increased nucleic acid turnover, or increased purine production. Uric acid is a metabolic by-product of purine compounds, which are derived from either dietary sources or the breakdown of DNA material within the body's cells. Uric acid is primarily excreted by the kidneys, but it can accumulate if its production exceeds excretion. A vast majority of patients with gout accumulate excessive uric acid due to underexcretion of the compound, although some cases of gout are caused by overproduction. Regardless of the cause, excessive intake of foods high in purine can contribute to hyperuricemia and thereby exacerbate gout, including red meats, seafood, and beer (Table 45-1).

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TABLE 45-1 Dietary Components Which May Affect SUA Levels
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Clinical Presentation

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The classic presentation for gout is an acute monoarthritis which is typically self-limited and often involves a joint of the lower extremity, such as the first metatarsophalangeal joint ...

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