Gout is a common disorder, which affects around 1% of the population. It is caused by excess uric acid, which exists as ionised urate in the blood. Saturated plasma urate (blood levels above 0.42 mmol/L) may slowly form monosodium urate (MSU) crystals that are deposited in the joints, kidneys, and soft tissues, eventually resulting in arthritis, kidney damage, and lumps under the skin respectively.
In healthy individuals, uric acid / urate is formed after eating certain high-protein foods. Usually most of the uric acid is then excreted by the kidneys in the urine. Excess urate in the blood can result from:
- A diet that is high in animal-based protein, especially meat and seafood.
- Moderate to high alcohol intake, especially of beer.
- High intake of fructose, a sugar found in sugar-sweetened soft drinks and fruit juices (apples and oranges).
- Being overweight - gout is associated with the metabolic syndrome.
- Some medications, including diuretics, low-dose aspirin and ciclosporin.
- Kidney disease can reduce urinary excretion of uric acid.
- Overproduction of uric acid can occur in disorders that cause high cell turnover, such as some myeloproliferative disorders (excessive numbers of cells produced by the bone marrow) and some types of anaemia (haemolytic anaemia and pernicious anaemia).
Other risk factors for gout include:
- Having a family history of gout.
- Age - in general, uric acid levels are elevated for 20 years before gout develops. In men uric acid levels rise at puberty so gout is often diagnosed in their 4th to 6th decade of life. Oestrogen protects young women from gout; uric acid levels rise at menopause and gout is often diagnosed in their 6th to 8th decade of life.
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