Gout is an inflammatory disease; more specifically, it’s a form of inflammatory arthritis. This disease is characterized by the deposition of monosodium urate crystals within the joints and connective tissue, which then gives rise to highly inflammatory, localized responses. This inflammation is ultimately caused by white blood cells, or leukocytes, which migrate to the joints to help reduce uric acid levels and release pro-inflammatory chemicals. As a result, the sufferer may experience pain, redness, tenderness, warmth, and swelling. When any of these symptoms occur, it is known as a gout attack, and these so-called attacks generally occur in the middle of the night, and with little to no warning.
The underlying cause of gout is hyperuricemia, a term which means there’s too much uric acid in the blood. In more scientific terms, hyperuricemia happens when levels of uric acid exceed the rate of its solubility, due to the fact that uric acid has limited solubility in body fluids. This can then lead to the formation of sharp, needle-like crystals in areas with slow blood flow, such as the joints and kidney tubules. Repeated gout attacks over longer periods of time can ultimately lead to arthritis, due to the wear and tear on the joints and the destruction of the joint tissue. Gout most often affects the base of the big toe, but can also affect joints in the ankles, knees, elbows, and wrists.
Monosodium urate crystals tend to form as a result of increased consumption or production of purines, or decreased clearance of uric acid. Additional risk factors for gout include obesity, diabetes, chemotherapy radiation, genetic predisposition, chronic kidney disease, and certain medications, such as aspirin and thiazide diuretics. Shellfish, anchovies, red meat, and organ meat are all considered to be purine-rich foods, while beverages containing high-fructose corn syrup are known to increase purine synthesis. On the other hand, dehydration as a result of not drinking enough water or consuming too much alcohol can also cause uric acid elevation.
For many sufferers, gout is a long-term disease, although it is possible to live a normal life as long as the disease is diagnosed early and the symptoms are treated properly. When left untreated, however, gout can lead to a number of complications and can also impact everyday activities due to fatigue, increased stress, and mood swings from a lack of sleep. More severe complications include tophi, joint deformity, kidney stones, kidney disease, heart disease, cataracts, dry eye syndrome, uric acid crystals in the lungs, and sometimes even death.
Treatment of gout attacks most often focuses on decreasing the pain and swelling with non-steroidal anti-inflammatory drugs, such as ibuprofen and naproxen sodium. Occasionally, corticosteroids and colchicine are also used, the latter of which inhibits the migration of white blood cells and therefore has powerful anti-inflammatory effects. In order to treat the underlying cause of gout, however, the recommended course of action is exercise and diet modification. This includes staying both active and hydrated, as well as avoiding soda, alcohol, red meat, and seafood. A couple of medications are also available to decrease uric acid levels, namely xanthine oxidase inhibitors and uricosuric drugs.
Resources:
- https://www.arthritis.org/about-arthritis/types/gout/what-is-gout.php
- https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897
- https://www.healthline.com/health/gout-complications#longterm-outlook