Decoding Gout: From Uric Acid Buildup to Attack Triggers
Gout is a complex form of arthritis that can occur in one or more joints but most often affects the big toe. Gout attacks can come on suddenly. The affected joint is swollen, tender, and hot, and even the weight of something like a bedsheet can be extremely painful. Symptoms usually appear suddenly at night. The pain is severe for as long as 12 hours after the onset of symptoms, and discomfort can last for days or weeks.
Gout has specific causes, and knowing what they are can help keep attacks under control.
How Uric Acid Causes Gout
Uric acid is created from the breakdown of purines, which are chemicals commonly found in some drinks and foods. Most of the time, uric acid dissolves in the blood and is eliminated through the kidneys, but if your body produces too much uric acid or if you have kidney problems that prevent enough of it from being removed, it can accumulate in the body.
What Is Hyperuricemia?
Hyperuricemia occurs when there is too much uric acid in the body. Uric acid crystals can form and accumulate in the joints, causing gout. Hyperuricemia does not always cause gout and does not need to be treated if it does not have any symptoms.
Risk Factor: Diet
Diets high in purine can trigger gout because the breakdown of purine produces uric acid. Foods high in purine include liver and other organ meats, red meat, anchovies, tuna, sardines, surgery drinks and sweets, game meats, and turkey.
Risk Factor: Weight
Obesity is a risk factor for chronic kidney disease and other kidney problems that can affect the body's ability to eliminate uric acid. People who are overweight are more likely to develop gout as much as ten years sooner than people of average weight. Gout is also more likely to affect people with excess belly fat.
Carrying excess fat also raises the risk of other health issues that can, in turn, increase the risk of gout, like diabetes, heart disease, and high blood pressure.
Risk Factor: Other Medical Conditions
Some other medical conditions increase the risk of getting gout. For example, one study in the U.S. found that people with psoriasis have a 1.7-fold increased risk of gout. A similar study in Taiwan found that people with psoriasis had a 1.3-fold increased risk of gout and that hypertension and COPD were contributing factors.
Risk Factor: Certain Medications
Some medications can also increase the risk of gout. Diuretics or water pills are one of the most significant causes of hyperuricemia because they affect how the kidneys function, which may alter how uric acid is eliminated.
Other medications that can cause gout include those prescribed to treat tuberculosis, immunosuppressive drugs, and aspirin.
Risk Factor: Family History of Gout
If you have a family history of gout, you are more likely to develop it, although it is currently unclear how much this factor increases risk. Many factors contribute to the development of gout; genetics is just one piece of the puzzle.
Risk Factor: Age and Sex
Gout is more likely to occur in biological males, mainly because males have naturally higher uric acid levels than females until menopause when female uric acid levels begin to equal male.
Because of this, males are more likely to develop gout at a younger age, usually between 30 and 50, while females generally do not develop gout until after menopause.
Risk Factor: Recent Surgery or Trauma
People at risk for gout or who have had gout in the past may develop postsurgical gout. One study found lower blood counts before surgery and anemia increased the risk of hyperuricemia because these conditions can affect how well the kidneys function. Blood loss is also a contributing factor.
Gout Attack Triggers
Gout attacks can be caused by many factors, including alcohol, certain foods, medications, illness, and trauma. Flares generally come on quickly and can last for a week or two; everyone experiences them differently.
Some people may have frequent flares, while others might only have them every few years. Gout flares can occur more frequently if left untreated, and symptoms can worsen.
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