Pathophysiology of Gout

Purines in the diet (part of proteins we eat) are metabolized to uric acid. Uric acid thus produced in the body is soluble in water and is ultimately excreted in the urine. Gout is a metabolic disorder of uric acid, secondary to excessive blood levels of uric acid. Excessive blood levels of uric acid can result either from increased uric acid production in the body or reduced excretion of uric acid by kidneys. Excess of uric acid crystallizes around multiple joints, causing inflammation, with pain, swelling, and limitation of range of motion in the joints involved, and results in development of gout.

Risk factors for elevated uric acid levels and development of gout

Elevated uric acid levels in the blood is called hyperuricemia, which can lead to development of gout. Elevated uric acid in the body and development of gout can be due to the following reasons:

1. Increased purine consumption:
Hyperuricemia is mainly secondary to increased protein consumption, especially proteins high in purine content, such as, organ meat and sea food. High amounts of purines consumed are metabolized in the body, resulting in increased production of uric acid. Alcoholic beverages, especially beer, also are rich in purine content. So, excessive consumption of alcohol can contribute to production of increased uric acid levels in the body. Uric acid produced is normally excreted by the kidneys. In hyperuricemia, uric acid is produced by the body in excessive quantities that are difficult to be excreted by the kidneys.

2. Cancers:
Various cancers in the body, such as, leukemia and lymphomas, result in production of defective cells that have a poor survival. Cancer patients can thus have more cell turnover. Death of the defective cells and increased destruction of cellular proteins result in increased production of uric acid, leading to hyperuricemia.

3. Chemo and radiation therapy:
Chemotherapy and radiation therapy can result in increased destruction to cells, with consequent cell death. Death of the defective cells and increased destruction of cellular proteins in individuals undergoing chemo and radiation therapy result in increased production of uric acid, leading to hyperuricemia.

4. Compromised renal function:
Uric acid produced in the body is soluble in water, dissolved in body fluids, and is ultimately excreted in the urine. Kidneys must be optimally functioning, to be able to excrete the uric acid produced. Individuals in renal failure and other compromised states of renal function cannot excrete all the uric acid in urine, resulting in progressively increased retention of uric acid in the body.

5. Dehydration:
Uric acid produced in the body is soluble in water, dissolved in body fluids, and is ultimately excreted in the urine. Individuals low on intake of fluids can have an issue with dissolving and excreting the uric acid produced. This can result in progressively increased retention of uric acid in the body and hyperuricemia.

Irrespective to the source of elevated uric acid levels in the body, the excess uric acid crystallizes around multiple joints, causing inflammation, with pain, swelling, and limitation of range of motion in the joints involved, and results in development of gout.

Foods to avoid for gout prevention

  1. As metabolism of purines yields uric acid, all food sources rich in purines can ultimately result in excessive uric acid production, which can contribute significantly towards activation and exacerbation of gout.
  2. All dietary sources rich in purines must be avoided or consumed sparingly by individuals with history of gout, to prevent an exacerbation of the condition.
  3. Organ meat such as, liver, spleen, brain, heart, and kidney of animals like cow, ox, pig, and sheep are very high in purine content and must be avoided by individuals with history of gout.
  4. Most of seafood and shellfish, such as, shrimp, anchovies, crabs, lobster, oysters, sardines, mussels, scallops, herring, trout, tuna, and codfish are rich in purine content and must be avoided or consumed sparingly by individuals with history of gout.
  5. Muscle meat of goose, duck, turkey, veal, and venison also are good sources of purines and must be consumed sparingly by individuals with history of gout, to prevent an exacerbation of the condition. Also, avoid gravies and sauces made of meat and other meat extracts, to prevent increased consumption of purines.
  6. Yeast and yeast extract preparations, such as, beer and alcoholic beverages are very rich in purine content and must be avoided or consumed sparingly by individuals with history of gout.
  7. Among vegetarian sources, artichokes, apricots, broccoli, brussels sprouts, cauliflower, mushrooms, oats, green peas, peanuts, parsley, and tofu are rich in purine content and must be consumed sparingly by individuals with history of gout.

Measures to prevent activation of gout

  1. As metabolism of purines yields uric acid, all food sources rich in purines can ultimately result in excessive uric acid production, which can contribute significantly towards activation and exacerbation of gout. All dietary sources rich in purines must be avoided or consumed sparingly by individuals with history of gout, to prevent an exacerbation of the condition.
  2.  Individuals with history of gout must keep a close watch regarding any new or worsening signs and symptoms of arthritis and joint inflammation. Report to your physician immediately regarding any exacerbation of pain, swelling, and limitation of range of motion in the joints affected by history of gout.
  3. Uric acid produced in the body is soluble in water, dissolved in body fluids, and is ultimately excreted in the urine. Individuals low on fluid intake can have an issue with dissolving and excreting the uric acid produced. This can result in progressively increased retention of uric acid in the body and hyperuricemia with increased risk for gout exacerbation. Watch out for new or worsening signs and symptoms of dehydration, such as, dry mouth, dry skin, confusion & dizziness, increased thirst, and reduced volume & concentrated yellow urine. Maintaining compliance with recommended daily fluid intake is an important step towards prevention of gout exacerbation.
  4.  Excess of uric acid in the body can crystallize in the kidneys and result in formation of uric acid stones (kind of kidney stones). Formation of kidney stones can result in symptoms such as, nausea, vomiting, low-back pain, pain and burning sensation during urination, poor urine output due to obstruction of urine flow by the stone, and increased risk for urinary tract infections. Individuals with history of uric acid stone formation must keep a close watch regarding any new or worsening signs and symptoms of renal stone formation. Report to your physician immediately regarding any findings suggestive of renal stone development.
  5. Patients with increased risk for development of urinary tract infections can often present with symptoms of UTI, such as, increased frequency of urination, pain and burning sensation near the urinary passage, foul smelling urine, fever, and chills. Individuals with history of UTIs must keep a close watch regarding any new or worsening signs and symptoms of urinary tract infections. Report to your physician immediately regarding any findings suggestive of UTI. Observe compliance with recommended daily fluid intake and other UTI prevention measures, to avoid any worsening of health status.