Gout is accompanied by recurrent acute arthritis. Patients suffer from sudden, even mid-night flare-up pain. Acute inflammation occurs primarily in the big toe, but can also develop in other joints of the foot (knee, ankle), and less commonly, the joints of the arm (wrist, elbow) and spine may also be affected.
The cause of the pain is the formation of needle-like uric acid crystals in the joints, which can also result in partial restriction of movement, making daily life more difficult. If gout is not treated, gout attacks can become more common and can lead to serious complications such as kidney failure because crystals can form within the kidney over time.
The appearance of gout can be caused by a disorder in the body's purine metabolism or by a malfunction of the renal excretion of uric acid.
In both cases, uric acid is produced in the body faster from the breakdown of purine than it could be excreted in the urine. Because uric acid is a end product in the human body, it can no longer transform (break down), its amount begins to rise in the blood. When uric acid levels reach a critical concentration, tiny uric acid crystals begin to deposit in the joints first, causing redness and swelling initially, followed by inflammation and burning pain.
The normal level of uric acid in the blood serum is in males 2.9-5.8 mg/dl, for women 2.4-4.3 mg/dl, but after menopause this value may be higher. As uric acid levels are considered acceptable below 6 mg/dl, even a small permanent increase can lead to a problem, especially for men.
What factors can influence the risk?
The development of gout can be greatly redounded by lifestyle habits. Eating large amounts of high purine foods (offal, meat, seafood) produces more uric acid, which takes more time to excrete. Consumption of sugary soft-drinks with a high fructose content can also lead to an increase in uric acid levels because purine synthesis is induced in parallel with the breakdown of fructose. In addition, regular alcohol consumption and obesity can greatly increase the risk of gout. For the above nutritional reasons, gout was previously considered a ‘disease of the rich’ because regular consumption of meat and alcohol could only be afforded by a close circle.
Genetic factors may cause the development of gout. One of the most important is a molecular pump called ABCG2, which is responsible for removing uric acid from the body. Some rarer variants of this protein are less effective in excreting uric acid in the urine. ABCG2 pump variants that pose a risk for gout development are found in all populations, but are more common in indigenous tribes in East Asia and the United States.
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