Gout is a very painful fairly common disease of the joints. It affects one joint and in 50 percent of the cases, the big toe is affected possibly due to the pressure on it from standing and walking.
Other joints that can be affected are those of the fingers, wrists, elbows or knees.
The pain of gout comes on suddenly without warning, usually at night. It is severe and is enough to awaken you.
While most people experience a gout attack that lasts for about up to a week, some people may be affected for a longer period of time. Such long-term gouty arthritis can lead to joint damage, which can be permanent.
Medication does help to relieve the pain and swelling symptoms and prevent any future attack. However, treatment of gout is long-term or can even be lifelong.
What causes gout?
Gout is typically caused due to the increase of uric acid levels in the blood. This is called hyperuricemia. Gout can, therefore, be due to increase in uric acid production or due to inadequate excretion of it or both.
Uric acid is produced in the body when the body breaks down substances called purines that are found in the foods that we eat.
Normally, uric acid is soluble in blood and the excess of it is excreted in the urine through the kidneys. However, in certain conditions, the body either produces an excess of uric acid or the kidneys do not filter off the excess uric acid into the urine. This results in an excess buildup of uric acid in the blood, which can cause gout.
Inadequate excretion of uric acid is the main cause in 90% of the gout cases. However, not every person who has hyperuricemia develops gout. Only 10% of hyperuricemia cases develop gout.
Due to high levels of uric acid in the blood, gout results from deposits of needle-like crystals of uric acid (sodium urate) in the connective tissue and the joint spaces.
This gives rise to sudden severe pain in the affected joint
Factors that can trigger gout
The trigger or risk factors are those that increase your uric acid levels in the blood and make you prone to develop gout.
1) Genetic cause of gout
In certain families, there is a genetic tendency for high levels of uric acid in the blood. Studies conducted by the John Hopkins scientists have shown that a particular gene is responsible for the manufacture of a particular protein.
This protein is responsible for the excretion of a uric acid derivative, sodium urate, through the urine by the kidneys. A genetic predisposition leading to a lack of efficiency of this protein leads to uric acid build up in the blood, which can lead to gout.
2) Age and gender
Gout is often thought of as being more of a man’s privilege than a woman’s. It affects four times more men than women and can occur in men of any age.
Women of reproductive age are unlikely to develop gout before menopause. This is because the female hormone estrogen, that is regularly released during the woman’s reproductive cycle increases the removal of uric acid through the kidneys.
After menopause, the uric acid in women tends to rise increasing the risk of gout. However, in general, the risk of developing gout is most after the age of 40 years in both men and women.
3) Purine-rich animal foods
Purines are natural substances, which are present in our body cells. When the cells die, the purines are converted into uric acid. This is a normal and healthy process.
Purine is found rich in a few foods of plant and animal origin. But, the purines from both these sources have a different impact. Purine found in plant foods and dairy products do not increase the risk of gout. It is the purines from red meat and shellfish that increase your risk of gout if you consume too much of them.
3) High alcohol intake
Alcoholic drinks, particularly beer, increase your risk of gout because they are high in purine content. Accumulation of purines leads to the excess of uric acid in the blood. Alcohol also interferes with the excretion of urates through the urine.
4) Impaired kidney function
The reason for this cause is obvious in that, a renal disease results in improper functioning of the kidneys, which again results in improper filtration and excretion of urates. This leads to uric acid build up in the blood, which can cause gout.
5) Obesity increases the risk of gout
According to recent research, obesity is a primary cause of gout. About half the people who suffer from gout are overweight.
Obesity puts a very high strain on the kidneys, which, as a result, do not function to optimal levels. Excretion of uric acid is hampered and this leads to uric acid build up in the blood, leading to gout.
Secondly, due to the high turnout of body tissue in the obese people, more uric acid is generated as a metabolic waste.
6) Certain medical conditions
Certain medical conditions are often associated with gout. They are:
- High blood pressure
- Abnormal lipid levels ( high levels of cholesterol and fats)
- Metabolic syndrome
- High fever
- Injury to the joint
- Certain diseases which cause excessive production of uric acid such as leukemia, lymphoma and hemoglobin disorders
- Any recent surgery can trigger a gout attack possibly due to the imbalance of body fluids as the patient does not take oral fluids before and after the surgery
- Lead poisoning
7) Certain medications
Certain medicines cause gout because they interfere with the excretion of uric acid. They are:
- Diuretics cause gout because they decrease the excretion of uric acid. Diuretics are mainly used in the treatment of high blood pressure, heart failure, cirrhosis of the liver and some kidney diseases.
- Niacin, also known as vitamin B3 or nicotinic acid, can trigger gout. They are used in lowering high cholesterol and triglyceride levels.
- Cyclosporine is also associated with gout. It reduces the activity of the immune system and because of this, it is mainly used after organ transplant surgery to reduce chances of organ rejection. It is also used in autoimmune disorders such as allergic dermatitis, rheumatoid arthritis and psoriasis among its other uses.
- Lead poisoning causes gout because it inhibits the excretion of urates from the body causing uric acid to build up in the blood.