There is no person who hasn’t heard of gout. However, people often don’t know that they are at risk of this condition, and it can happen to them at any moment. Hospital admissions after a wild party with friends are particularly common. But let’s delve into this issue in more detail and understand why it happens at such moments, even if a predisposition to gout is genetic.
What is Hyperuricemia?
Hyperuricemia is an elevated level of uric acid in the blood. This condition can remain asymptomatic for many years, while uric acid crystals continue to accumulate in the joints.
What is Gout?
Gout is an acute inflammatory response of the body to the accumulated uric acid in the joints. The big toe is most commonly affected by gout, typically on one side of the body. This actually distinguishes gout from rheumatoid arthritis, where the joints on both sides are inflamed symmetrically.
Symptoms of Gout:
Acute gout attacks can last from 3 to 10 days. During an acute attack, the affected joint becomes warm to the touch, red, and swollen. The pain can be so intense that it can be compared to childbirth. Symptoms may be absent between gout attacks.
What are Tophi?
If gout attacks are left uncontrolled, the disease can progress into a chronic form. This can lead to the formation of lumps called tophi around the joints. Tophi develop in the soft tissues surrounding the joints, where salt deposits occur. Over time, tophi can irreversibly damage and deform the joints.
If tophi form, they can only be removed surgically. They contain salt, the same uric acid crystals. Removing tophi will not restore the joint’s previous functionality, so sometimes it becomes necessary to replace the affected joints with implants.
For example, if a tophus develops on the knee joint and the joint loses the ability to move completely, it will need to be replaced. However, it is not possible to undergo such a surgery quickly, as there is usually a waitlist of several months or even years for such procedures. The waiting time must be endured with significant restrictions, practically without movement. This harms health no less than gout itself. Take care of your joints, as they cannot simply be replaced with artificial ones.
Some statistics
According to statistics, approximately 1 million residents of Canada suffer from gout. On average, this accounts for 1 to 4% of the population, with typically 4 men affected for every 1 woman. Research shows that higher testosterone levels decrease the ability to excrete uric acid through the kidneys, leading to increased uric acid accumulation in the body.
For the same reason, there is a higher risk for those who undergo long-term hormonal therapy, which includes testosterone, as well as women with elevated testosterone levels. This segment of the population also requires increased attention from the medical community.
Furthermore, it is known that gout more commonly affects older individuals, so as life expectancy increases, the prevalence of gout also rises. Studies indicate a likelihood of developing gout of up to 9% for men over 80 years old and 6% for women of the same age, which is significantly higher than the average rates.
Risk factors for gout
- Floor;
- Age;
- Overweight;
- Ethnic group;
- Genetic component;
- Certain health problems:
- Kidney insufficiency: 90% of gout cases are associated with kidney problems that hinder uric acid excretion, rather than issues with uric acid production in the body;
- High blood pressure;
- Thyroid problems;
- Type 2 diabetes;
- Sleep apnea;
- Injury.
What are the causes of gout?
As mentioned earlier, the cause of gout is the accumulation of uric acid. But how does uric acid appear in the body in the first place? Uric acid is formed as a result of purine breakdown.
This happens for three reasons:
- Consuming excessive amounts of foods high in purines;
- Overproduction of purines in your body;
- Inefficient elimination of purines from your body.
How Purines Form or Enter the Body?
There are specific processes in the body that result in the production of more purines than usual. These processes include:
- Due to dehydration;
- As a result of the digestion of food:
- Red meat;
- Subproducts;
- Some seafood. I want to note right away that most seafood has anti-inflammatory properties and is recommended for gout patients.
- Alcohol (primarily beer);
- Carbonated drinks;
- Fructose and fruit juices.
- Due to kidney problems;
- When using certain medications, including aspirin and diuretics;
- Due to genetic factors. If you have family members who have been diagnosed with gout, you are at higher risk;
- Some studies indicate that having psoriasis increases the risk of gout;
- Smoking also exacerbates the situation.
Recommendations for Assessing Associated Problems
Here is a list of issues recommended to be checked and given attention to if an acute gout episode has already occurred
- Overweight
- Joint condition
- Diet – the presence of foods that can lead to a second episode of gout;
- Consumption of alcohol, any alcohol, but beer is considered the most dangerous drink;
- Type 2 diabetes;
- High blood pressure;
- Cardiovascular diseases;
- Medications, some of which can increase uric acid levels;
- High cholesterol;
- A history of kidney stones;
- Other chronic kidney problems;
- Presence of genetic problems;
- Intoxication with heavy metals (lead).
All of these problems can worsen the situation, so it is recommended to pay attention to them in order to reduce the risk of recurrent gout attacks. Each attack leads to increasing joint damage and can eventually result in decreased joint mobility and complete immobility.
Treatment of gout
The treatment of gout should be prescribed by a doctor, and self-medication should be avoided at all costs. Medications that lower uric acid levels have several side effects, which is why they are never used without a history of acute gout attacks.
These medications aim to relieve acute inflammatory processes and control uric acid production. Additionally, the doctor will always recommend lifestyle changes.
In the case of gout risk, the diet is quite specific. By the way, this is another reason why following fad diets is not necessary. With gout, it is important to limit the consumption of fatty foods, so the ketogenic diet is not suitable for such individuals. More precisely, it needs to be modified slightly to avoid harming the body. A juice-based diet may increase the likelihood of a gout attack more than not following any specific diet at all.
Can Gout Be Prevented?
Even if there is a genetic predisposition to this problem, it is possible to reduce the likelihood of developing gout by making lifestyle changes.
Although elevated uric acid levels do not necessarily warrant medication to control uric acid levels in the blood, there is nothing stopping you from taking certain steps to reduce the risk of gout. One of them is weight reduction if you are overweight. Another is heavy metal detoxification. The third is an anti-inflammatory diet.
Anti-inflammatory Diet:
Exclude fructose, sucrose, fruit juices, and sweetened non-alcoholic carbonated beverages from your diet. High insulin levels increase the risk of a gout attack;
- Exclude all alcoholic beverages from your diet, not just beer;
- Limit the consumption of omega-6 fatty acids;
- Reduce the intake of grains and carbohydrates;
- Coffee is not a product that needs to be excluded;
- Drink an adequate amount of fluid throughout the day.
All of these measures will not only help reduce uric acid levels but also have a positive impact on your overall health.
Personal Observation:
Since uric acid testing is part of the Enhanced Healthy Living Assessment – the most cost-effective set of tests that I often order, I am well aware that when a high level of uric acid is detected, I receive a call from the laboratory urging me to contact the patient immediately and inform them of the risk of gout attacks. Often, patients are unaware that they have high uric acid levels because they have never had this test done before. Simply because this test is not part of routine screenings.
That is why this test is often done only in hospitals when people seek treatment for the typical inflammation of the big toe joint caused by gout. As you may have already understood, this means that the deposition of salts has already occurred, and this process is irreversible. From then on, the goal is to try to keep the situation under control to avoid recurrent attacks.
Furthermore, while in other countries, it is recommended to periodically check uric acid levels after the age of 40, there is no such standard in Canada, so you have to take care of it yourself. Although I do see high uric acid levels at a very early age, I often see it in children as well.
I will end on a positive note. Uric acid is not our enemy; it is an antioxidant that helps preserve the brain. Therefore, there is rarely dementia or Parkinson’s disease in those who have gout. It is possible to have higher uric acid levels and not have gout; that is probably the golden mean to strive for. In that case, the brain will be preserved, and the joints will not be in pain.
Arthritis Society Canada: Gout
Kerr GS, Qaiyumi S, Richards J, Vahabzadeh-monshie H, Kindred C, Whelton S, Constantinescu F. Psoriasis and psoriatic arthritis in African-American patients–the need to measure disease burden. Clin Rheumatol. 2015 Oct;34(10):1753-9. doi: 10.1007/s10067-014-2763-3. Epub 2014 Aug 28. PMID: 25164561