Gout Disease is seen in people whose blood Uric Acid level is higher than normal. About 70% of the uric acid in our body comes from the breakdown of the protein called Purine in our cells. What makes up the remaining amount of uric acid comes from the breakdown of Purine in the foods we eat.
Having uric acid in your blood does not necessarily mean you will have gout. Healthy individuals also have uric acid in the blood, with males higher than females. If the amount of uric acid in the blood begins to increase, your body tries to excrete the excess part in the urine through the kidneys. However, if your body is producing too much uric acid or the kidneys are not able to excrete enough uric acid, the amount of uric acid in the blood begins to increase. If the amount of uric acid exceeds a certain level (Dissolution point), it is possible for the uric acid to transform into an insoluble crystalline form as Sodium Urate. These crystals generally tend to form in or around the joint tissues. They occur in areas such as the toes and ankles, especially on the ends of the legs.
The formed uric acid crystals slowly accumulate in the cartilage tissue over the years and eventually one day empties into the joint space. Hard, needle-shaped crystals come into contact with the soft surface of the joint (Synovium) and rapidly cause an inflammatory process. With the inflammatory process, the crystals break down in the joint and the gout attack slowly resolves within days.
In addition to causing sudden inflammatory attacks in the joint, these crystals can form structures called tophi by accumulating in and around the joint. These hard structures, called tophi, can grow over time and cause compression damage to cartilage and bone, and this damage can cause constant joint pain, as in calcification. Gout Disease at this stage is called “Chronic Tophus Gout”. Sometimes tophus can be palpated subcutaneously. Apart from the joints, they can also accumulate in cartilage structures such as the auricle.
The factors that affect your uric acid level in the blood are as follows:
Your genetic makeup may cause your kidneys to not be able to remove enough uric acid from the body, even if there is no other dysfunction. This is the most likely cause, especially in individuals with a family history of similar disorders.
The larger the body mass, the higher the daily uric acid production. Therefore, uric acid production in those who are overweight may be more than the kidney can handle.
If you have high blood cholesterol and fat levels, high blood pressure and type 2 diabetes, your kidneys may not be able to excrete enough uric acid. The combination of all these problems is called “Metabolic Syndrome”.
In some kidney diseases, your kidney may not be able to adequately excrete uric acid.
Some medications such as diuretics and aspirin can increase the amount of uric acid in the blood.
Rarely, in some chronic blood diseases, a large number of blood cells are produced and if the amount of uric acid released by their breakdown is high, the kidney may not be able to cope with it.
If a clear cause can be identified that can explain the increase in uric acid (for example, kidney disease or use of diuretics), this situation is called “Secondary Gout Disease”. However, it is often not possible to identify a single obvious cause, many factors are combined (For example, in an individual with excess weight, the kidney cannot adequately excrete uric acid due to genetic reasons) and this situation is called “Primary Gout Disease”.
If you have a tendency to gout, it is necessary to know some situations that will trigger a gout attack:
Impact or forceful movement on the affected joint
Diseases with high fever (cold, pneumonia, etc.)
Surgical interventions
Eating excessively and/or drinking large amounts of alcohol
Thirst
Similar attacks in the disease previously called pseudo-gout are caused by the formation of calcium pyrophosphate crystals. can occur by accumulation in the joint. In this disease, it is not uric acid that accumulates in the joint, but calcium crystals, and unlike Gout, it causes symptoms in the knee and other joints rather than the big toe in individuals with calcification.
