What Are The Main Causes Of Gout – Here’s what to expect at each stage of gout, and how to prevent it from getting worse in the first place.

Gout is a form of inflammatory arthritis that occurs when levels of uric acid, a normal byproduct of metabolic reactions in the body, are too high. Uric acid begins to crystallize when levels are too high for your body to easily dissolve and excrete (through urine). Uric acid crystals are deposited in the joints, causing severe inflammation. The big toe is a well-known site for gout attacks, but gout can attack many different joints throughout the body.

What Are The Main Causes Of Gout

Gout is one of the oldest recorded diseases, with records dating back to ancient Egypt. As Dr. Thomas Sydenham described it in the 17th century, this extremely painful form of arthritis affects millions of American adults today, just as it did throughout history:

What Is Gout? Symptoms, Causes & Diagnosis

“The victim went to bed and slept soundly. At about 2 a.m. he woke up with severe pain in his big toe; more rarely in his heel, ankle or instep… It was a moderate pain at first, then became more severe …The sensation in the affected part is so delicate and lively that it cannot bear the weight of bedding and the weight of a person’s jar walking about the room.”

Fortunately, today gout is one of the most treatable forms of arthritis—some rheumatologists say it’s curable. But for too many gout sufferers, the disease goes untreated or undertreated. For example, in one recent study, only 37 percent of gout patients took the urate-lowering drug allopurinol; only half of those with frequent gout attacks took the drug.

Improper treatment of gout can lead to further worsening of the condition. Over time, gout can begin to affect more joints throughout the body and lead to problems such as tophi and permanent bone damage.

Learn more here about how gout develops, how gout progresses through its different stages, and how to treat gout to prevent symptoms, lower uric acid levels, and prevent long-term gout complications.

Gout: Causes And Risk Factors

Also called silent hyperuricemia, in the early stages of gout, uric acid builds up in the blood and begins to form crystals around joints, most commonly in the feet.

Uric acid is produced when your body breaks down substances called purines, which are produced in your body and are also found in some foods and drinks. While eating high-purine foods can lead to high uric acid levels, many experts believe the role of diet in the development of gout has been overemphasized. Chronically high uric acid levels occur when your kidneys are unable to remove uric acid effectively, which can occur for a variety of reasons, including:

“In the first stages of gout, patients have no joint pain, no redness or swelling in the joints, but elevated uric acid in their blood tests,” says Theodore R. Fields, MD, FACP, a rheumatologist at the Hospital for Special Surgery in New York City. R. Fields) said city. “This is when uric acid or urate crystals accumulate in the joints, which may subsequently cause inflammation.”

But high uric acid alone is not enough to diagnose gout. “Most patients with hyperuricemia never develop clinical gout,” says Alireza Meysami, MD, FACR, FACP, a rheumatologist at Henry Ford Health System in Michigan.

Gout Flare Ups: Causes And Treatments

“This refers to pain, redness and swelling in a patient’s joints, most commonly the big toe, foot, ankle or knee, but gout can start in other joints as well,” says Dr. Fields. “This is when urate crystals are released into the joint fluid and cause an inflammatory response, bringing in many white blood cells and releasing inflammatory chemicals that cause pain, redness and swelling.”

If you think you are experiencing a gout attack, talk to your primary care doctor or rheumatologist to start treating the disease. It’s important to see your doctor during a gout attack because your doctor may want to remove fluid from the affected joint and view it under a microscope to check for the presence of uric acid crystals. Identifying uric acid crystals in joint fluid can help diagnose gout.

After a first gout attack, 75 percent of people will have another attack within a year; Dr. Fields said, but some people can take action years before another attack occurs. The intermediate stage is when “a person has had a gout attack but currently does not have any joint pain or swelling,” he said. “Almost all gout patients go through this phase because the nature of gout is that you have a gout attack and then a period of calm before the next gout attack.”

Although it may seem like nothing is happening, this is the moment when patients should begin long-term treatment. Lowering uric acid levels with medication can prevent future gout attacks and the long-term complications that come with them.

Psoriatic Arthritis Vs. Gout: Symptoms, Causes, Treatment

This stage is also called “tophus gout” because uric acid deposits can form nodules called “tophus”, usually located at the bunion point of the big toe or at the elbow. But tophi can form anywhere on the body. “At this stage, a person will almost always have some joint pain from gout,” says Dr. Fields. “It usually takes years of uncontrolled gout to get to this stage.”

During this stage, progressive damage to the joint occurs, so people with gout should receive treatment before this occurs. “Delaying treatment can make gout worse,” Dr. Messami says.

As you become more familiar with the symptoms of gout, you may be able to sense that a gout attack is coming. “Increased pain, swelling, redness, and warmth in the affected joints during an attack are signs that the attack is progressing,” says Dr. Messamy.

In addition, the disease in general may progress with “recurrent or more frequent gout attacks, longer duration, involvement of more joints, and the presence of tophi,” Dr. Messami said.

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Dr. Fields says if you have more than one gout attack per year, it’s important to take your gout medication regularly.

If left untreated, gout usually progresses. Additionally, certain factors may trigger a gout attack. “Anything that causes urate levels to rise or fall suddenly can trigger gout,” says Dr. Fields.

This may include eating foods rich in purines, which break down into urates, such as red meat and shellfish. Foods rich in fructose also increase the body’s production of urate. Alcohol reduces the excretion of uric acid in the urine, causing increased uric acid levels. Specifically, “not only does beer affect uric acid in the urine, but the protein in beer breaks down into purines, which then form uric acid, so it increases uric acid in two ways,” says Dr. Fields.

While you may want to limit high-purine foods to prevent gout attacks, both doctors we spoke with said diet alone is not enough to control gout. “Severe dietary purine restriction is rarely recommended because it only lowers mean serum [blood] uric acid levels by about 1 mg/dL, which is not sufficient in most patients,” says Dr. Meysemi.

Gout: Signs, Symptoms, And Complications

Gout was once called the “disease of kings,” but it was misunderstood to be caused solely by overeating. “Gout is a genetic disorder in which your body either excretes too much uric acid in the urine or produces too much uric acid, rather than a dietary disease,” says Dr. Fields. “Watching your diet can certainly help relieve gout attacks, but to counteract a genetic predisposition to gout, you will almost always need medication.”

So if you find that certain foods cause gout symptoms, avoid them. “Consumption of alcoholic beverages or fatty foods may trigger gout attacks in some patients, and individual patients should avoid triggers known to cause gout attacks,” Dr. Meysemi said.

However, one of the risk factors for gout is obesity. In fact, gout has become more common recently, possibly due to rising obesity levels. “Weight loss in obese people has a greater urate-lowering effect than a purine-free diet,” Dr. Meysemi said. For this reason, a healthy diet and exercise can help you lose weight and reduce the chance of the disease progressing.

Emotional stress can also cause gout attacks. Physical trauma to the foot, such as that which may occur during running, can also cause this condition, which may release some crystals and cause an inflammatory response.

High Uric Acid Levels (hyperuricemia)

“We don’t stop people with gout from running or doing other exercises,” Dr. Fields said. “However, if someone has a gout attack in their feet, ankles or knees, we recommend that they stay away from their feet as much as possible, as further trauma to the affected joints can prolong the gout attack.”

Starting a treatment regimen may also inadvertently trigger a flare-up. But other medications can also be taken to help mitigate this risk.

Fortunately, due in part to its long history, gout is one of the best understood and easiest to treat forms of arthritis with medication.

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