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.
Gout is a disease characterized by an abnormal
metabolism of uric acid, resulting in an excess of uric acid in the tissues and blood. People with gout either produce too much uric acid, or more commonly,
their bodies have a problem in removing it. There are a number of possible
consequences of this buildup of uric acid in the body, including acute and
chronic gouty arthritis, kidney stones, and
local deposits of uric acid (tophi) in the skin and other tissues. Gout may occur alone (primary gout) or may be associated with other medical conditions or medications (secondary gout).
The prevalence of gout appears to be increasing. It is currently estimated to be affecting over
6 million Americans.
Gouty arthritis is a common cause of a sudden onset of a painful, hot, red, swollen joint, particularly in the foot at the big toe. Gouty arthritis is reportedly the most common cause of inflammatory arthritis in men over the age of 40. It is definitively diagnosed by detecting uric acid (monosodium urate) crystals in an aspirated sample of the joint fluid. These uric acid crystals can accumulate in the joint and tissues around the joint over years, intermittently triggering repeated bouts of acute inflammation. Repeated "attacks" of gouty arthritis, or "flares," can damage the joint and lead to chronic arthritis. Fortunately, while gout is a progressive disease, there are effective medications to treat gout.
Medical Author: William C. Shiel Jr., MD, FACP, FACR
Medical Editor: Jay W. Marks, MD
is a disease that results when crystals of uric acid form in tissues of
the body. Gout is characterized by an overload of uric acid in the body and
recurring attacks of joint inflammation (arthritis). Chronic gout can lead
not only arthritis, but hard lumps of uric acid in and around the joints, decreased
kidney function, and kidney stones. Gouty arthritis
is usually an extremely painful attack with a rapid onset of joint inflammation.
The inflammation is precipitated by the deposition of uric acid crystals in the
lining of the joint (synovial lining) and
the fluid within the joint. Intense joint inflammation occurs when white blood cells engulf the crystals of
uric acid and release chemicals that promote inflammation. The resulting inflammation causes pain, heat, and redness of the joint.
Gout is a common disorder of uric acid metabolism that can lead to deposition of monosodium urate (MSU) crystals in soft tissue, recurrent episodes of debilitating joint inflammation, and, if untreated, joint destruction and renal damage.