What is gout?
- It’s a common form of arthritis
- Crystal deposition where monosodium urate crystals form in the joints and tissues.
- Painful inflammation is caused in one or more joints in the extremities and nodules in the soft tissues –tophi.
- Hyperuricemia increases the risk of gout as well as other diseases, such as hypertension, kidney disease and metabolic syndrome.
What is Uric acid metabolism?
- In humans it is the final product of purine metabolism, which are components of nucleosides (building blocks of DNA and RNA.
- Purine molecules are important for survival for vertebrates and humans, who have developed excellent systems for making sufficient purine nucleosides for their metabolisms by using materials available like glucose, glycine and glutamine
- Excess purine’s are removed from the body as it gets broken down in the liver and excreted from the kidneys.
- Purines are converted into intermediate uric acid and then gets metabolised by the enzyme uricase into allantoin.
- This is a soluble compound that flows easily through the blood stream, and filtered by the kidneys, and then excreted.
- Levels of uric acid depend on 2 factors:
- The rate uric acid is made in the liver, and the determent of blood uric acid levels from the kidneys.
- Humans are able to preserve blood levels of uric acid, by increasing antioxidant capacity in the blood. This is due to the fact that uric acid is an important antioxidant in the body fluids, which are responsible for neutralising free radicals in the blood stream.
- Humans cannot produce vitamin C, thus the reason we have the ability to preserve uric acid to compensate for that.
- Low blood uric acid levels may risk neurological disorders such as Amyotrophic Lateral Sclerosis, Multiple sclerosis, Huntington’s, Parkinson’s and Alzheimer’s.
How does Hyperuricemia affect the development of gout?
- Uric acid is a waste product with poor solubility in body fluids, and has a role as a primary antioxidant, and should be kept at healthy levels in the blood.
- Hyperuricemia is a risk factor for gout, as a gout attack increases with blood uric acid. It is also a risk factor for other diseases.
- Urate deposits show inflammation in the joints and surrounding soft tissues.
- Acute gout appears suddenly with inflammation in joints in lower extremities, skin could also be shiny and red in the affected area. Attacks are often early morning and can last up to 6-24 hours with severe pain.
- Attacks are triggered by these factors, these also decrease the level of urate in the blood, infection, trauma to a joint, rapid weight loss, dehydration, acidosis and low body temperature.
- If gout is left untreated, it can cause significant joint damage and loss of function.
What role does Hyperuricemia play in other conditions?
- It’s the main cause of high blood levels of uric acid and cause the risk of kidney and bladder stones.
- This also causes the risk of forming uric acid stones and calcium oxalate stones, which is higher in patients with gout.
- Hyperuricemia is a risk factor for cardiovascular diseases such as, heart failure, stroke, hypertension, high blood pressure all contribute to high blood uric acid as blood flow is to the kidneys are reduced, and urate excretion.
What are the risk factors for Gout?
- Increases with age
- More common in men
- Associated with other medical disorders such as hypertension, obesity, renal insufficiency, early menopause, Hypercholesterolemia and surgery.
- Some medications increase the risk of gout, such as diuretics, ant tuberculosis drugs, cyclosporine and levodopa
- Aspirin taken in low doses inhibit excretion and increase blood levels. Higher doses will reduce these levels.
- Dietary influences that increase the risk of gout, are high-purine foods, such as red meat, fish and shellfish, as well as pork and lamb.
- Alcoholic beverages higher the risk of gout, but wines does not affect this at all.
- Fructose that’s found in orange juice for example can higher the risk for gout.
How do you diagnose and treat gout?
- Presents with inflamed, painful joints in the extremities
- Other conditions are pseudo gout – an accumulation of calcium phosphate crystals in joints, septic arthritis – inflammation in joints,
- Blood tests can determine if the patient is hyperuricemic
- A symptom of recurrent gout episodes, have urate crystals in the joints, this can be detected via ultrasound a non-invasive method.
- Corticosteroids and colchicine are treatments to manage pain and inflammation.
- Aspiration of affected joints can be done to relieve pressure, this is done by a injection of long-acting steroids.
- Patients should be encouraged to change their lifestyle which can reduce the risk of gout.
- This is done by lowering purine diets, weight loss and exercise
- Xanthine oxidase inhibitors – effect of lowering uric acid production
- Uricosuric drugs – increases the excretion of uric acid from the kidneys, and reduces the absorption of uric acid from the kidneys back into the blood.
- These drugs increase urinary uric acid levels, and may cause kidney stones
- Can also be surgically removed.
What are the new innovative drugs available to treat chronic gout?
- Mammalian uricase enzyme – Injectable medication that delivers uricase enzymes into the blood, once it’s in the blood stream the enzyme breaks down uric acid into allantoin, and is excreted by the kidneys.
How can your diet control Hyperuricemia and help reduce gout?
- Exercise daily and reduce weight
- Limit red meat intake
- Limit your fish intake
- Drink skim milk and other low fat dairy products
- Consume vegetable protein, nuts, and legumes
- Decrease alcohol intake
- Decrease intake of sugar sweetened beverages
- Vitamin C
- Chinese herbs – cinnamon
How do Anti-inflammatory nutrients play a role in chronic gout?
- Hyperuricemia and urate crystal formation contribute to chronic gout.
- Cells are stimulated to produce pro-inflammatory cytokines, which send inflammatory white blood cells to where the crystal dispositions are
- Nutrients that have been noted to reduce the inflammation in joints and reduce pro-inflammatory cytokines are Curcumin and omega-3 fatty acids and resveratrol.
- Omega-3 supplements are more suited to hyperuricemia patients with a limited fish intake.