Our bodies all have a breakdown product called urate (or uric acid). Gouty Arthritis Most urate is produced by the body. It breaks down substances known as purines and usually passes out in our urine.
If urate does not pass out of the body, or if you produce too much, it can build up and form crystals. Gout is caused when these crystals build up and form around the body’s joints, causing inflammation and pain.
Purines are found naturally in the body and also in some foods, such as shellfish, red meat and offal, and certain alcohols, such as beer and stout. Drinking a lot of alcohol can also cause dehydration, which makes gout more likely to occur. Dietary purines account for 5-10 per cent of total purines in the body.
Urate builds up either because too much urate is being produced by the body or because not enough is being passed out in urine (which may indicate kidney disease). Some other diseases can also increase your likelihood of developing gout, including heart disease, psoriasis and the treatment of some blood disorders such as leukaemia.
Not everyone with high urate levels will develop gout. We do not know why some people develop it. However, if you are overweight you are more likely to develop it. A good diet and weight loss will reduce your chances of developing gout.
According to the latest research genes may play a part in increasing your risk of developing gout.
The following are risk factors for gout:
if you are very stressed or have had an illness
if you injure or bruise a joint. If you are prone to gout, and you have more pain in a joint than you would expect after a minor bump, it could be an attack coming on, so get treatment straight away
by taking diuretics (water tablets) or low-dose aspirin. Some people take these for high blood pressure or to prevent heart disease
Pseudogout is a similar condition to gout, where sudden attacks of inflammation affect a joint. It is caused by calcium phosphate crystals, not urate crystals, and usually affects knees, shoulders or wrists, rather than toes. It is treated differently to gout, and is not covered here.
Gout usually affects the big toes. It can affect other joints such as ankles, knees, hands, wrists or elbows, especially in people who get gout when they are older.
A joint will start to ache, then swell up and become red, hot and extremely painful. The joint may look as if it has a boil on it, or the skin can become shiny and peeling. The joint will be stiff.
You might also get a temperature and feel very tired. An attack of gout can last from 1-10 days, then die down, doing no permanent damage to the joint. There can be years between attacks.
However, if you get lots of attacks (which is rare), you can develop more permanent arthritis in the joint, which can damage it (chronic gout).
Chronic gout can also cause tiny white lumps (tophi) to appear under your skin, especially on your ears, fingers or elbows. This is where urate crystals form under the skin. They can be painful.
If your urate levels are especially high, it can build up in the kidneys as stones, so you will need treatment to reduce the levels.