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Gout

Introduction

Gout is an inflammatory joint disease where disease where meat is broken down into purines and uric acid, which is deposited as crystal deposits in and around joints. When meat and alcohol are consumed together, it makes gout worse. In the middle ages gout was a disease of the affluent and royalty was afflicted by gout.

Gout is actually only one of the manifestations of a faulty uric acid metabolism. Kidney stones are another manifestation. Apart from uric acid crystal disease there are other crystal-induced diseases such as pseudogout, which is produced by precipitation of another crystalized salt, calcium pyrophosphate dihydrate (CPPD). The other name for pseudogout therefore is CPPD crystal deposit disease. These crystal deposits cause an inflammatory arthritis that leads to scarring and a lack of range of motion, if it is not detected early and treated.

Not everybody can handle uric acid in their system as well as the person next door. Uric acid is one of the breakdown products of meat. We are all born with slightly different enzyme patterns. However, the person that cannot break down purines as well will end up with too much uric acid in the system until it reaches a critical point of solubility where it preciptates as uric acid crystals.

Gout leads to uric acid deposits

Gout leads to uric acid deposits

When uric acid levels exceed 7.0 mg/dL (or 0.41 mmol/L) in plasma, a critical point is reached where monosodium urate crystals, which under the microscope look like micro-needles, will be spontaneously deposited in tissue with a lack of blood supply such as tendons, joints, ligaments or cooler tissues such as ear lobes. This point can also be reached in patients who have leukemia, lymphomas, hemolytic anemias or other cancers where purines are overproduced because of rapid cell division. Some children are born with an enzyme defect, which leads to uric acid kidney stones, severe gout and kidney damage at a young age. Most cases of gout though are in adults and are often associated with an overindulgence of meals containing large helpings of meat in combination with consumption of alcohol. This might be part of the explanation why males are much more commonly affected by gout then females (ratio of 20:1).

 

References:

1. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 55.

2. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999.

3. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders

4. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

5. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevi

Last modified: November 14, 2014

Disclaimer
This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.