Cause of Gout

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Gout is caused by too much uric acid in the blood (hyperuricemia). Hyperuricemia usually does no harm, and most people with high levels of uric acid in the blood never develop gout. The exact cause of hyperuricemia sometimes goes undiscovered, although inherited factors (genes) seem to play a role. When uric acid levels in the blood are too high, uric acid may form crystals that accumulate in the joints. Gout can seem to flare up without specific cause or can be brought on by factors such as:

• Certain conditions related to diet and body weight, such as:
• Obesity.
• Moderate to heavy alcohol ingestion, particularly beer.
• A diet rich in meat and seafood (high-purine foods).
• Very low-calorie diets.
• Medications that may increase uric acid concentration, such as:
• Regular use of aspirin or niacin.
• Medications that reduce the amount of salt and water in the body (diuretics).
• Medications that cause rapid cell death (chemotherapy, usually used to treat cancer).
• Medications that suppress the immune systems, such as cyclosporine, that are used to prevent your body from rejecting an organ transplant.
• Major illness or certain medical conditions, such as:
• Rapid weight loss, as might happen in hospitalized patients who have changes in diet or medications.
• Chronic kidney disease.
• High blood pressure.
• Conditions that cause an abnormal rapid turnover of cells, such as psoriasis, multiple myeloma, hemolytic anemia, or tumors.
• Lead poisoning.
• Hypothyroidism.
• Surgery.
• Having been born with a rare condition that causes high blood uric acid levels. People with Kelley-Seegmiller syndrome or Lesch-Nyhan syndrome have a partial or complete deficiency in an enzyme that helps to control uric acid levels.

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Gout Prevalence and Incidence

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According to the National Health and Nutrition Examination Survey III, 1988-1994, an estimated 5.1 million people in the United States suffer from gout.

Gout is the most common form of inflammatory arthritis in men. Gout affects approximately 3 times as many men as women, and men are more likely than women to have gout at all ages. Racial and ethnic differences are not as distinct among patients in the US, though African Americans aged 45 years or older are more likely to have gout than Caucasians in the same age group.

Some worldwide prevalence observations:

• Black Africans, Japanese, and Native Americans have generally lower levels than Caucasian populations.
• Compared to other populations, higher urate levels are found in adult ethnic men in Oceania.
• Ethnic groups in Malaysia and China have higher mean urate levels than most Caucasian populations.

In one longitudinal study, the cumulative incidence of all gout was 8.6% among men, with a median age at study entry of 22 years and a median follow-up of 29 years. In general, gout has an annual incidence of 1 to 3 per 1000 men. The rate in all women is approximately 1 in 5000; however, the incidence of gout in women increases after menopause.

There is also some evidence that the prevalence and incidence of gout appear to be rising. Multiple studies over the last 40 years have provided data consistent with a considerable increase in prevalence and annual incidence in Westernized industrial countries.

Asymptomatic hyperuricemia is the first stage in the development of gout. Although most individuals who have elevated serum urate levels do not develop gout, control of hyperuricemia becomes one of the primary goals of gout management once gout has been diagnosed.

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