By In-house Team, Circle Health Group

What is the main cause of gout?

Gout, a widespread form of arthritis, is often caused by increased uric acid levels, resulting in significant joint pain, typically starting in the big toe

the word gout written in letters across wooden blocks with medication pills scattered around

Gout is a type of inflammatory arthritis that affects between 1 and 2% of the population in the UK. It causes sudden, severe inflammation, leading to pain and swelling in your joints. Gout is most common in the big toe, but can affect other joints such as the ankles, knees, wrists, elbows, and fingers.

For centuries, gout was misconceived as ‘the disease of kings,’ or a ‘rich man’s disease,’ due to it being associated with eating excessive amounts of rich foods such as red meat, seafood, and alcohol. Today, we understand that its causes are more complex. While diet does play a role, there are many other factors involved and some people appear susceptible to developing the condition, while others remain unaffected.

What is gout?

Gout occurs when levels of uric acid, a waste product from certain foods, build up in the blood, a condition called hyperuricaemia. Uric acid is a chemical produced by the body when it breaks down food and drinks containing purines. Most uric acid normally dissolves in your blood and is filtered through your kidneys and passed out in your urine. If your body produces too much uric acid, or your kidneys don’t excrete it effectively, hyperuricaemia may occur.

Having high levels of uric acid in your blood does not necessarily mean you will develop gout, and many people with hyperuricaemia never develop symptoms.

Symptoms of gout appear when sharp crystals of uric acid clump together in your joints, causing sudden pain and swelling. This is known as a gout attack or flare up.

How is gout treated?

Treatment for gout normally takes the form of a combination of medication and lifestyle changes.

Who does gout affect?

Gout is more common in men than in women, and it usually develops in middle age. Women are unlikely to develop gout before the menopause, as the female hormone oestrogen increases removal of uric acid by the kidneys. Gout occasionally affects younger people, and when it does the symptoms are usually more severe.

What are the symptoms of gout?

Gout symptoms commonly start in the big toe, though other joints may be affected. A gout attack often starts at night, with symptoms often at their worst after around 12 to 24 hours. Attacks can last from a few hours to several days or even a couple of weeks. Symptoms normally ease off gradually with or without treatment.

During a gout attack, you may experience:

Intense pain in the affected joint
Red, shiny skin over the affected joint
Severe tenderness, even to a light touch such as a bedsheet
Swelling around the joint
A feeling of warmth around the joint
Joint stiffness

How often do gout attacks occur?

You may experience a gout attack once in your lifetime, or they may occur once or twice a year. Some people have frequent, severe attacks (chronic gout) which may affect more joints, last longer, and become more severe over time. People with advanced gout may develop tophi, hard lumps of uric acid crystals that form in and around joints, and other parts of the body. Chronic gout can eventually lead to permanent joint damage and deformity, which may require surgery.

A key cause is having high levels of uric acid in the blood, known as hyperuricaemia. However, An estimated 21% of the population has hyperuricaemia but never develop any symptoms of gout.

What are the causes of gout?

Gout is a complex condition with several possible causes. A key cause is having high levels of uric acid in the blood, known as hyperuricaemia. However, An estimated 21% of the population has hyperuricaemia but never develop any symptoms of gout. And conversely, some people may experience a gout attack even if they have normal uric acid levels.

Who is at risk of getting gout?

Several factors can increase your risk of developing gout. These include your family history, diet, and certain health conditions and medications.

Some things that can increase your risk of gout include:

A family history of gout
Increasing age
Being overweight or obese
Drinking alcohol (even moderate amounts can trigger an attack)
Eating foods high in purines like organ meats, and seafood
Consuming drinks that contain high-fructose corn syrup like soda and some juice drinks

Health conditions

Some health conditions that may increase your risk of gout include:

Chronic kidney disease — kidney disease prevents your body from filtering and eliminating uric acid effectively
High blood pressure (hypertension)
Diabetes
Conditions like psoriasis, and haemolytic anaemia that affect your body’s production of cells
Rare conditions such as Kelley-Seegmiller syndrome or Lesch-Nyhan syndrome, where there is a complete or partial deficiency of the enzyme needed to regulate uric acid levels, causing a build-up of uric acid in the blood

Medications

Some medications have been shown to increase your risk of developing gout. If you are worried about any of the medications you are taking, speak to your consultant. Never stop taking any prescribed medication without checking with your consultant first.

Some medications that may increase your risk of gout include:

Aspirin (acetylsalicylic acid) — a medication used to relieve pain and inflammation. Low dose aspirin can also reduce the risk of a heart attack or stroke in high-risk patients
Diuretics (water tablets) — medications that help your body get rid of excess fluid
Niacin (vitamin B3) — when taken in large amounts
Cyclosporine — a medication that suppresses the immune system

A study in China examined the relationship between alcohol consumption and the development of uric acid crystals... heavy drinkers with gout were roughly twice as likely to develop uric acid crystals as non-drinkers.

Recent research on the causes of gout

Scientists are still learning about the possible causes of gout. A recent study linked the deficiency of a protein called lubricin to developing symptoms of gout. Lubricin is a protein that lubricates joints and inhibits inflammation. It also appears to prevent uric acid crystals from clumping together in the joint, the main cause of pain and inflammation during a gout attack.

Another Korean study looked at the link between lifestyle factors, metabolic syndrome and gout. They found that men with metabolic syndrome, a combination of high blood pressure, abdominal obesity, high blood sugar and high triglycerides, were four times more likely to develop gout.

A further study in China examined the relationship between alcohol consumption and the development of uric acid crystals. Their findings suggest that heavy drinkers with gout were roughly twice as likely to develop uric acid crystals as non-drinkers.

What can trigger a gout attack?

A gout attack happens when uric acid crystals clump together around your joint, triggering your immune system and causing inflammation, pain, and swelling.

Several factors may trigger a gout attack, including:

Injury to a joint

A knock or injury can cause inflammation, attracting uric acid crystals to the joint.

Dehydration

Not drinking enough water can affect your kidneys' ability to flush out uric acid.

Certain medications

Starting or irregularly taking gout medication, particularly at a high dose, can trigger an attack.

Surgery

Sometimes, gout can flare up after surgery (known as post-surgical gout).

Arsenic exposure

Low levels of arsenic, found in some pesticides, soil, water, and shellfish, have been linked to an increase in uric acid in the blood and a higher prevalence of gout in women.

Diet

Eating a large meal, especially rich in purines (found in foods like red meats and seafood), or consuming alcohol and drinks with high-fructose corn syrup can trigger an attack.

When should I see a doctor?

Gout can have similar symptoms to other conditions, such as an infected joint that requires urgent treatment. If you have symptoms of gout, make an appointment to see a consultant as soon as possible.

You should seek medical attention if:

You have symptoms of gout but haven’t previously been diagnosed with the condition
You’ve already been diagnosed with gout, and have symptoms of a gout attack
Your symptoms haven’t improved after a couple of days of taking medication for gout

Can gout be prevented?

Sometimes, it may not be possible to prevent gout. However, there are steps you can take to reduce your risk of developing gout and prevent or reduce gout attacks.

Some things you can do to prevent or reduce gout attacks include:

Drink two to four litres of fluid every day
Lose weight, or maintain a healthy weight
Avoid or limit alcohol
Follow a low purine diet
Take any gout medications as prescribed

Conclusion

Gout is a common condition with several possible causes. In the past, misconceptions about gout may have led people to feel that gout was something to be embarrassed about, or that the condition was ‘their fault’ due to their diet and lifestyle choices. We now know that gout is not simply the result of an indulgent lifestyle, and that far from being a ‘rich man’s disease,’ it can affect people from all walks of life.

With more education and a greater understanding of what causes gout, the stigma surrounding the condition is beginning to fade. In addition, new research into the causes of gout may make it easier to prevent or reduce gout attacks, improving the quality of life for many with this unpleasant and painful condition.