What is Gout?


Gout is the deposition of uric acid crystals in various tissues and organs like tendons, joints and kidneys, resulting in inflammation and damage.

Humans are the only animals to develop spontaneous primary Gout, with the higher primates, reptiles and birds developing it in renal failure or when fed high fructose and purine diets. This is due to the evolutionary loss of uricase (an enzyme which breaks down uric acid into soluble allantoin for excretion) in humans and other higher primates. A high purine and fruit sugar intake compounds the accumulation of poorly soluble uric acid, resulting in the clinical manifestations of Gout in people with genetic mutations which further impair the excretion of uric acid through the gut and kidneys.

What are the Symptoms of Gout?

Gout attacks commonly occur in the ankle and big toe joints, usually affecting men and postmenopausal women, who may also have associated metabolic conditions like diabetes, hypertension and high cholesterol. Diet and alcohol have direct impact on this arthritis.

The attacks typically reach a peak of excruciating pain in 6 hours from onset, but usually resolve in 5 days. As the disease worsens, attacks become more frequent, and last longer, to the point on constant inflammation and pain.

What are the Treatments Available for Gout?

Xanthine Oxidase inhibitors (which reduce uric acid production) and Uricosuric agents (which increase the excretion of uric acid) are the mainstay of Urate Lowering Therapies. Rarely, Uricase is needed to break down urate crystals rapidly, like in impending acute kidney failure. IL1 inhibition is effective in treating refractory inflammation.

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