What is Gout?
Gout is an inflammatory disease in which monosodium urate crystals deposit into a joint making it red-hot tender and swollen. Within hours when this happens it’s called a gaudi attack the underlying cause of gout is hyperuricemia too much uric acid in the blood which results in the formation of sharp needle-like crystals in areas with slow blood flow like the joints in the kidney tubules.
Overtime, repeated Goudy attacks can cause destruction of the joint tissue which results in arthritis to understand where the uric acid comes from let’s start with purines which together with pyrimidines are nature’s most common nitrogen containing heterocycles.
A hetero cycle is a molecular ring with different types of atoms purines as well as pyrimidines are key components of nucleic acids like DNA and RNA and when cells along with the nucleic acid in those cells are broken down throughout the body those purines are converted into uric acid a molecule that can then be filtered out of the blood and excreted in the urine.
Uric acid has limited solubility in body fluids though hyperuricemia happens when levels of uric acid exceed the rate of its solubility which is about 6.8 milligrams per deciliter at a physiologic pH of about 7.4 uric acid loses a proton and becomes a urate ion which then binds sodium informs monosodium urate crystals these crystals can form as a result of increased consumption of purines like from consuming purine rich food like shellfish anchovies red meat or organ meat also though they can result from increased production of purines for example high fructose corn syrup containing beverages could contribute to the formation of uric acid by increasing purine synthesis.
Another way crystals could form is from decreased clearance of uric acid which can result from dehydration from naturally enough water or consumption of alcoholic beverages both allowing uric acid to precipitate out regularly eating these kinds of foods can also lead to obesity and diabetes both of which are risk factors for a gout.
hyperuricemia can also develop as a result of chemotherapy or radiation treatment since cells die at a faster than normal rate also some individuals have a genetic predisposition to over production of uric acid, while others with chronic kidney disease may be unable to excrete the uric acid finally there are some medications like thiazide diuretics into aspirin which can also increase the levels of uric acid and therefore the risk of gout.
Gout most often affects the first metatarsal joint of the foot or the base of the big toe and when it does this condition is called pellagra. classically in po de gras a person will wake up from sleep feeling like their big toes on fire even the weight of the sheets can be painful the pain is most severe in the hours immediately following the attack and then generally lessons with time but that discomfort and swelling can last for days or even weeks. lt can also affect other joints as well like those in the ankles the knees the wrists and the elbows.
DIAGNOSIS AND TREATMENT
This inflammation and local pains ultimately caused by white blood cells or leukocytes which migrate to the site to help eliminate uric acid and release pro-inflammatory chemicals including cytokines treatment of a Gaudi attack is typically focused on decreasing the pain in the swelling most often with non-steroidal anti-inflammatory medications or NSAIDs like ibuprofen or naproxen sodium but occasionally with corticosteroids as well colchicine which has anti-inflammatory effects by inhibiting white blood cell migration has also been used for a long time to treat gout attacks, to treat the underlying cause of increased uric acid though it’s important to modify the diet, doing things like staying well hydrated with water as well as reducing or eliminating soda alcohol red meat and seafood and staying active to ward off obesity there are also medications that help to decrease uric acid levels which includes xanthine oxidase inhibitors like allopurinol.
Xanthine oxidase is an enzyme involved in the breakdown of purines to uric acid so inhibiting this enzyme results in less uric acid production uric Osirak medications like probenecid increased excretion of uric acid by the kidneys over time repeated gaudiya attacks can develop into chronic gout which is the type of arthritis with joint tissue destruction and permanent joint deformity.
Chronic gout can eventually lead to permanent deposits of urinals called TOFA which form along the bones just beneath the skin individuals with chronic gout are also at an increased risk for developing kidney stones made of uric acid as well as urate nephropathy which is when urate crystals deposit in the interstitial of the kidney okay as a quick recap gout is a type of inflammatory disease that typically affects the first metatarsal joint which is the base of the big toe where uric acid precipitating sodium urate crystals which deposit in the joint and lead to inflammation in pain thanks for reading.