True arthritis is also known as gout or podagra. The disease is caused by uric acid crystals precipitating - most often in articular cartilage around the joints but also in the arms and legs, bones, connective tissues, or in organs. The precipitation of uric acid may also cause kidney stones. The accumulation of uric acid can be caused by the kidneys not excreting enough uric acid.
The symptoms come in attacks, they often affect a specific joint which will become red and very painful like in the case of an inflammation. The inflammation can be caused by the immune system attacking the uric acid crystals, and fever and shivers might occur. The attack most often ceases in a couple of days.
Podagra
When the metatarsophalangeal joint of the big toe is affected it is called podagra. The first outbreak most often occurs after a good meal (rich in purine) in combination with alcohol.
True arthritis is included under the heading of lifestyle diseases even though it is possible to have a hereditary disposition. Too much food containing purine, such as meat - especially offal but also meat soup, and poultry, yeast, shellfish, mackerel, herrings, sardines, and anchovies aggravate the disease. The same goes for alcohol, fat, and sugar. Food with a low content of purine is, for example: eggs, cereals, nuts, olives, and fruit. Many podagra patients are overweight and suffer from blood pressure- and blood sugar problems.
These things can be present on their own or in a combination. Not nearly everyone who suffer from high levels of uric acid in their blood experience rheumatic attacks, e.g. podagra, but podagra can be a forewarning of gout.
The disease is absolutely mostly occuring in men; seldom before the age of 30 and most often around the age of 50. There is a hereditary tendency. The disease often starts suddenly, most often during the night, accompanied by pain, flushing, and swelling of one or more joints, most often in the legs and particularly often in the metatarsophalangeal joint of the big toe.
The attack is often provoked by alcohol, a large meal, medicine, damages, or surgical procedures. It can last from days to weeks after which it totally disappears. More than 50% have another attack within a year, but many years might also pass before the next attack occurs. Later attacks have a tendency to being linked, being severe and sustained and to being accompanied by fever. Gout and chronic polyarthritis, therefore, can be difficult to distinguish from one another.
The essential thing about gout is the elevated level of uric acid in the body. This might be caused by too large a production or a delayed excretion of uric acid (which is sparingly soluble) - or a combination of both.
When disregarding hereditary disturbances of the uric acid metabolism, diuretic treatment is one of the most important causes of too high a level of uric acid in the blood as a lack of fluid in the body - in connection with diuretic treatment - leads to a larger re-absorption and a decreased excretion of uric acid. Acetylsalicylic acid, nicotinic acid, and alcohol can also result in too much uric acid in the blood.
