Gout is an inflammatory arthritic condition that is typically characterized by a red swollen joint, most often the big toe, that is sensitive to touch. It is a common medical condition that accounts for approximately 5% of all arthritic cases. The incidence of gout has increased in recent decades, believed to be due to risk factors such as longer life expectancy and changes in diet.
Hyperuricemia – elevated levels of uric acid in the blood – is the underlying cause of gout. Uric acid is the final metabolite in the purine metabolic pathway. As humans lack a functional uricase enzyme that breaks down uric acid, it is usually secreted out of the body by the kidneys. However, when there is an accumulation of uric acid in the blood stream due to high intake of purine-rich food and/or under-excretion by the kidneys, the excess uric acids in the blood stream crystallize and are deposited in joint spaces and/or surrounding connective tissues. This leads to inflammation in the joint, causing swelling, redness, heat and pain, and accounting for all of the clinical symptoms of gout.
A number of risk factors are associated with gout – one of which is lifestyle. A high intake of purine-rich food can cause high levels of uric acid in the blood. Purine-rich food include meat and seafood, which is why gout was historically known as the “disease of kings.” Large consumption of meat and seafood is associated with an increased risk of gout. Interestingly, purine-rich vegetables such as spinach and mushrooms are not associated with increased risk.
Drinking too much alcohol can also lead to hyperuricemia. Alcohol metabolism produces adenosine monophosphate which is converted to uric acid for excretion. In addition, lactate generated through alcohol consumption increases uric acid re-absorption by the kidneys.
Certain medical conditions and medications can also contribute to increased risk of gout. For example, hypertension, insulin resistance, hyperlipidemia and abdominal obesity (combined as metabolic syndrome) is commonly associated with gout – occurring in nearly 75% of cases. Other conditions include lead poisoning and renal failure. Certain medications such as diuretics and aspirin are also associated with attacks of gout.
Overall, there are many factors that are associated with an increased risk of gout. Any number of these factors could combine and cause hyperuricemia , leading to uric acid deposits in joints. If you suffer from any of the symptoms described above, it is important to seek professional medical advice as soon as possible.
Reginato, AJ. (2005) Gout and other crystal arthropathies. Harrison’s Principles of Internal Medicine 16th Edition. USA: McGraw-Hill Companies, Inc.