By Nathan Wei
Once known as a disease of kings and wealthy men, gout has made a comeback in the pantheon of diseases affecting Western culture.
The incidence of gout is on the rise. Many reasons for this have been posited by experts. These include the epidemic of obesity endemic to the United States. In addition, food additives such as high fructose containing corn syrup used in many processed foods and soft drinks is also a culprit.
This article will describe 7 facts for understanding why gout develops.
The primary villain responsible for gout is uric acid (UA). This is a byproduct of the metabolism of purines, substances found in different foods. While animals have the ability to break down UA using an enzyme called uricase, human beings do not. The end result is an accumulation of UA with subsequent deposits of UA in joints and other body tissues. Gouty arthritis, which is how gout usually presents, is a painful, debilitating condition.
1. Gout affects about 3 per cent of the population, almost 8 million Americans. While men are affected more often than women, there is a spike in the incidence of the disease in postmenopausal women.
2. While the common myth is that the problem is overproduction of UA, most gout occurs because the kidneys don't get rid of UA fast enough.
3. Overproduction is seen in some diseases such as leukemia and lymphoma, particularly during treatment when cancer cells are destroyed. This leads to a marked increase in blood UA levels.
4. One type of arthritis that is characterized by an elevated blood UA level is psoriatic arthritis. The underlying reason is the high cell turnover seen in this condition. This can also be a "fooler" because it can be mistaken for gout.
5. Four causes of excess UA production are excess consumption of foods high in purines, obesity, and alcohol consumption. A variety of drugs can also cause excessive UA accumulation as a result of overproduction.
6. Inability to get rid of UA can be seen with kidney diseases of various types.
7. Predisposing factors to UA deposits include joint damage due to osteoarthritis, a drop in joint temperature (which is why attacks affect the feet at night), and dehydration.
The end result of UA accumulation is deposits of UA (monosodium urate) crystals in body tissues. This occurs when the serum UA remains above 6 mg/dl. In future articles I will describe attacks, how they present, and the treatments.
Nathan Wei, MD, FACP, FACR is a rheumatologist and Director of the Arthritis Treatment Center http://www.arthritistreatmentcenter.com. He is a former Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and consultant to the National Institutes of Health. For more info: Arthritis Treatment
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