Discover what causes gout and gout pain
These are the most common questions that patients ask about gout
- What is gout?
- How common is gout?
- How does my doctor know that I have gout?
- What else could my joint pain be due to if it's not due to gout?
- Does gout cause any complications and when will I be better?
What is Gout?
Gout is a condition in which monosodium urate crystals deposit in
joints and other tissues, such as soft connective tissue or in the
urine, bladder and kidney system.
Here are some useful gout related definitions:
Gouty arthritis is arthritis
due to urate crystals in joints
Podagra is the name given to hot and angry gouty
arthritis of the big toe
Tophi is the name given to observable nodules
caused by urate deposits in soft connective tissues like skin and
gristle beneath the skin surface.
Chronic tophaceous gout is the combination of
tophi and a chronic severe arthritis
Gouty urinary lithiasis is the presence of
urate-containing stones in the urinary tract
Urate nephropathy is a form of kidney damage due
to the formation of urate crystals in the kidney
The natural story of gout has three phases:
- A long period with no symptoms when there is simply too much uric acid or urate in the blood.
- A period during which acute attacks of gouty arthritis are followed by variable intervals (months to years) when there are no symptoms
- The final period of chronic tophaceous gout with both gout arthritis pain and gout Tophi on the skin
What causes gout?
Doctors and scientists now know that gout is the end result of a complex chain of events, We still don't fully understand how urate crystals stimulate the inflammatory responses that result in gout, and how this is interrupted by anti-inflammatory drugs.
Urate crystals can form in any tissue (except brain). Urate crystals are found in joints affected by gout, but they have also sometimes been found in
Joints with no symptoms
The uric acid gout crystals trigger inflammation in the joint, in the skin and sometimes in the kidney.
At normal body pH, the urate crystals are about 98% dissolved in blood and body fluids. Urate crystals don't dissolve easily and it doesn't take much of a change in the body pH to make them appear again as crystals.
It's a known fact that urate levels are higher in men than women. This explains why more men than women suffer from gout. The fact that temperatures in the feet and hands can be low enough to precipitate urate from plasma explains why gout tends to attack joints in the hands or feet (and sometimes the knees or the elbows).
The same reasoning explains why tophi typically form in the skin or cartilage of the earlobe, finger tips, back of the elbows and other cool anatomical sites.
The body gets rid of excess urate through the urine or the bowel. Urate excretion is two-thirds by the kidneys and one third by the gut.
About 90% of those people with a high blood urate level simply don't secrete enough urate from the kidney or the bowel. Only about 10% make too much of it in the first place. Only a very few have a combination of under-excretion and overproduction of urate.
Often no cause can be identified for people having a high blood urate level.
However, a high blood urate level and gout can be secondary to several factors. These factors are:
- A high or higher than normal alcohol intake
- Kidney disease or kidney function impairment
- Hypertension or high blood pressure
- Medication and drugs
- Lead toxicity
- Excessive dietary intake of protein
- Some blood cell cancers
- Some anti-cancer treatments
- Psoriasis
How common is Gout?
A study in the UK showed that about 15 people in every thousand suffer from gout.
Men are nearly four times more likely to get it than women.The overall ratio of men to women was 3.6:1=20
The higher the blood urate level - the higher the risk of gout
Although gout is more likely to occur in people with high blood urate levels, it can occur in people with normal plasma urate levels; and many people with a high blood urate level never develop gout
Gout is very rare in women before the menopause unless they have an underlying genetic problem that causes very high blood urate levels.