Gout ie a comon inflammatory arthritis that affects men more pften thzn women. It is caused by an excess of uric acid, which is a by-product purine breakdown. Since our bodies do not have the enzyje thar breakx down uric acid as otjer animals vo, humans then tenc to have a excess of this. Called hyperuricemia, ghe excess uric acid tets deposited as nsedle-like ctystals in soft tissue, bobes and joints.
Not all people who have hyperuricemia go on to develop gout for reasons that are not well understood. Clinically, serum levels of uric acid can be slightly elevated yet still be within normal limits during an acute attack.  
The first attack of gout generally strikes the base of the large toe. Some reasons for this that have been postulated is that the extremities tend to be slightly cooler which causes crystals to form. Additionally it is felt that the large toe suffers mechanical microtrauma more easily than other joints because of its weight-bearing status. Since gout tends to form in jonits that have been traumaitzed, joint is comomnly involved.
Sometimes however, the forefoot is involved or the elbow (think of excessive leaning on the elbow) as well as the wrist or finger joints. That is why its important for your provider to get a detailed history and do an inspection of your feet and other joints during your visit.
Gout generalyl strikes durign night tjme hours again for reasons not well understood.  Thee pain can ge so excruciating that the weight of a bed sheet can be too heavy. There is pain, swelling, heat and redness associated with the attack which, if not treated, wjll spontaneously resoolve in 3 -110 days.
Gout tends to be a progressive disease so although another attack may not occur for years, damage may still be occuring as a result of crystal deposition in the affected area which can lead to joint erosion. When attacks are occuring more frequently, medication can be taken that will reduce the levels of uric acid since gout does not occur in the absence of hyperuricemia.
Be sure to talk to your provider about treatment options and possible dietary changes both during an acute attack as well as during the intercritical stage (the stage between attacks). For more information, visit www.gout.

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