Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
The tendency to develop gout and elevated blood uric acid level (hyperuricemia) is often inherited.
Gout and hyperuricemia are aggravated by
weight gain, alcohol intake,
high blood pressure, fructose in corn syrup found in soft drinks, abnormal kidney function, and certain medications.
Gout pain attacks can be precipitated by
dehydration, injury, fever, heavy eating, heavy alcohol consumption, and
recent trauma or surgery.
The most reliable diagnostic test for gout is the
identification of crystals in joints, body fluids, and tissues.
The treatment of an attack of gouty
arthritis is different than the treatment of
hyperuricemia. There are two key concepts essential to treating gout. First, it is critical to stop acute inflammation of joints affected by gouty arthritis. Second, it is important to address the long-term management of the gout disease in order to prevent future gout arthritis attacks and shrink gouty
tophi crystal deposits.
What is gout? What is hyperuricemia?
Gout is a disease that results from an overload of uric acid in the body. This overload of uric acid leads to the formation of tiny crystals of urate that
deposit in tissues of the body, especially the joints. When crystals form in the joints, it causes recurring attacks of joint
inflammation (arthritis). Gout is considered a chronic and progressive disease. Chronic gout can also lead to deposits of hard lumps of uric acid in the tissues, particularly in and around the joints and may cause joint destruction, decreased kidney function, and kidney stones (nephrolithiasis).
Gout has the unique distinction of being
one of the most frequently recorded medical illnesses throughout history. It is
often related to an inherited abnormality in the body's ability to process uric
acid. Uric acid is a breakdown product of purines that are part of many foods we
eat. An abnormality in handling uric acid can cause attacks of painful arthritis
(gout attack), kidney stones, and blockage of the kidney-filtering tubules with
uric acid crystals, leading to kidney failure. On the other hand, some people
may only develop elevated blood uric acid levels (hyperuricemia) without having manifestations of gout, such as arthritis or kidney problems. The state of elevated levels of uric acid in the blood without symptoms is referred to as asymptomatic hyperuricemia. Asymptomatic hyperuricemia is considered a precursor state to the development of gout. The term gout refers the disease that is caused by an overload of uric acid in the body, resulting in painful arthritic attacks and deposits of lumps of uric acid crystals in body tissues.
Gouty arthritis is typically an extremely painful attack with a rapid onset of joint inflammation. The joint inflammation is precipitated by deposits of uric acid crystals in the joint fluid (synovial fluid) and joint lining (synovial lining). Intense joint inflammation occurs as the immune system reacts, causing white blood cells to engulf the uric acid crystals and chemical messengers of inflammation to be released, leading to pain, heat, and redness of the joint tissues. As gout progresses, the attacks of gouty arthritis typically occur more frequently and often in additional joints.
Reviewed by Melissa Conrad Stöppler, MD on 5/31/2012
Foods that you eat, and don't eat, can impact your gout by increasing or decreasing your blood uric acid levels. You will also want to make adjustments to your dietif you have any of the conditions that are commonly found in people with gout, including, hyperlipidemia, hypertension, diabetes, obesityand impaired glucose tolerance.
The primary dietary goal for gout is to limit your intake of foods with high amounts of purinein them. Ideally, you will have little or no foods that are high in purine and only small amounts of those with moderate amounts of purine.
A sedimentation rate is common
blood test that is used to detect and monitor inflammation in the body. The sedimentation rate is also called the
erythrocyte sedimentation rate because it is a measure of "...