Causes of Gout: What Triggers the Disease

Gout is remembered at the moment of an attack: sudden severe pain, redness, and swelling of a joint. But the attack is the finale of a process that has been going on for years. Let us break down the mechanism step by step.

What happens in the body with gout

Waste products are constantly formed in the body, and one of them is uric acid. As long as there is little of it, it dissolves in the blood, passes through the kidney filter, and leaves with urine. The failure begins when there is more acid than the elimination system can remove in time: either the body synthesizes it more actively, or the kidneys excrete it less well. The concentration in the blood rises — this is hyperuricemia.

Hyperuricemia is not the same as disease: in many people it causes no problems. But in some people the acid forms needle-shaped crystals that deposit in joints and cause inflammation. The same crystals can cause kidney stones.

Uric acid and purines: the main cause

Uric acid is a breakdown product of purines, and purines are present in the body's own tissues and in many foods. Hence two paths to excess: more purines coming in and less excretion going out. Sources of purines:

• red meat, especially organ meats;
• certain types of fish and seafood;
• alcohol, especially beer — it contains guanosine and xanthine, precursors of uric acid;
• products with fructose, as well as cocoa, tea, chocolate, peas, lentils.

A separate scenario is increased cell breakdown: during antitumor therapy or massive apoptosis in autoimmune diseases, purines increase not because of food but because of internal processes.

Gout and alcohol: what is known about the link

The link was noticed long before blood tests: even Celsus described it alongside kidney dysfunction. The mechanism is twofold: alcohol can enhance uric acid synthesis and inhibit its excretion, and beer additionally supplies ready-made precursors — guanosine and xanthine. Therefore the question of "vodka and gout" is decided not by the name of the drink but by dose and regularity: strong alcohol follows the same pathways.

Other risk factors: heredity, weight, kidney disease

Gout is more common in men, and frequency increases with age: the peak in men is 40–50 years, in women 60 years and older. Before menopause women rarely get sick — this is associated with the influence of estrogens on acid excretion; the male-to-female ratio is from 7:1 to 19:1. Heredity also plays a role, including rare genetic conditions.

Risk factors include excess weight, kidney disease, high blood pressure, metabolic syndrome, heart failure, high cholesterol, diabetes, psoriasis, and certain tumors. Medications also matter: diuretics, some blood pressure drugs, low-dose aspirin, certain immunosuppressants, high doses of niacin. An attack is triggered by a febrile illness, a generous portion of alcohol or a very heavy meal, dehydration, joint injury, or surgery.

Why gout was called the disease of kings

From the Middle Ages to the 20th century, gout affected mainly the nobility — hence "disease of kings," "disease of the rich," "disease of aristocrats." The explanation is simple: the wealthy had more meat on the table, and overeating meat and excess weight are known risk factors. In 1739 Mouchron sang the praises of "noble gout," and later Ellis and Orowan linked it with genius. The legend is beautiful, but statistics have trimmed it: today gout affects 2% of residents of the USA and Europe, and titles have nothing to do with it.

What is known about gout prevention and when a doctor is needed

Hyperuricemia is detected in 4–12% of the population, while about 0.1% in Russia suffer from gout — elevated acid is far more common than the disease itself. Gout prevention is linked to the same risk factors (excess weight, alcohol, diet); specific recommendations are given by a doctor.

A doctor is needed at the first attack and if the usual treatment does not help. At the appointment they ask about diet and alcohol and order a blood test for uric acid; if the picture is unclear, they refer to a rheumatologist and examine more deeply — they take fluid from the joint with a thin needle and perform ultrasound or a special CT scan. Without treatment an attack lasts 1–2 weeks, subsequent ones are longer, and over time persistent joint damage, tophi, and kidney stones appear.

Gout by itself is not a reason to call an ambulance. Numbers 103 and 112 are needed if, against the background of sudden pain and swelling in a joint, the pain intensifies, a very high temperature rises, chills, fever, nausea, or inability to eat appear: such signs may indicate an infection inside the joint.

Gout is a rare case where the mechanism is understood down to the last crystal, and a conversation about causes is more useful than a conversation about symptoms. This material is for reference and does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer