Understanding Gout: More Than Just Diet

Gout affects over 1% of the adult population and is the most common inflammatory arthritis in men over 40.

What causes Gout? Uric acid is a breakdown product of purines (found in food and body cells). Normally filtered by kidneys. When blood uric acid exceeds 6.8 mg/dL, monosodium urate crystals form and deposit in joints, causing intense inflammation.

The Classic Gout Attack: - Begins suddenly, often at night - Severe pain, redness, warmth, swelling — classically in the big toe (podagra) - Can affect ankle, knee, wrist, elbow - Peaks within 24 hours, resolves spontaneously in 1–2 weeks without treatment

Beyond Diet: Diet accounts for only ~10–15% of uric acid levels. The majority is from endogenous production. Most gout patients have a genetic predisposition affecting uric acid excretion. Medications like diuretics, aspirin, and cyclosporine also raise uric acid.

Long-Term Risks of Untreated Gout: - Tophi (chalky urate deposits under skin) - Joint destruction - Uric acid kidney stones - Increased cardiovascular risk

Treatment: - Acute: Colchicine (most effective within 12 hours), NSAIDs, Steroids - Prophylaxis during initiation: Low-dose Colchicine for 3–6 months - Urate-lowering therapy (ULT): Allopurinol (start low, go slow), Febuxostat - Target: Serum uric acid < 6 mg/dL (< 5 mg/dL if tophi present)