Causes and Symptoms of Gout

Gout is medical disorder, where there are recurrent attacks of severe inflammatory arthritis of various joints of body. The attack of flare-up causes severe pain, swelling and tenderness of affected joint. The most common joint involved in gouty arthritis is metatarsophalangeal joints of big toes, which accounts for approximately half of the cases. Other joints that are commonly involved include other smaller joints of hands and feet (fingers and toes), wrist joint, heels, and knees.

What are the signs and symptoms of gout?

The presenting symptom of gout can vary, but most commonly it presents as acute attack of inflammation of involved joint which becomes red, swollen, hot and tender. The symptom usually starts at night (may be due to lower body temperature at night) and continues for several days if left untreated.

Gout and hyperuricemia may also present as fatigue, high fever with joint pain. Sometimes gout may present as painless deposition of uric acid crystals in various joints, which are known as “tophi”. Uric acid crystals may also be deposited in kidneys (as renal stones), tendons and surrounding tissues.

What is the cause of gout?

Gout occurs when there is deposition of uric acid crystals in various joints and tissues, especially when there is high uric acid content in blood.

Regarding uric acid, patients of gout can be divided into two categories, under-excretors or uric acid and over producers of uric acid. Under-excretors account for approximately 90% of gout patients, who have defective uric acid excretion mechanism and as a result may not be able to excrete uric acid via kidneys effectively and cause accumulation of uric acid in blood (hyperuricemia). Remaining 10% are over producers, they have normal excretion mechanism, but produce more uric acid than normal and as a result lead to hyperuricemia.

Not all individuals with high blood uric acid level (hyperuricemia) suffer from gout, but they are at higher risk of developing gout, especially those with very high uric acid level, the higher the level, the higher is the risk. If uric acid level is more than 7 mg/dl, the risk of developing gout is approximately 0.5% per year, but the risk become 4.5% per year if uric acid level is more than 9 mg/dl.

Ultimately the cause of gout and hyperuricemia can be diet (excess and regular consumption of foods with high purine content), genetic predisposition and under-excretion of uric acid salts etc.

 




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