Causes and Risk Factors of Gout

Gout is a form of arthritis characterized by sudden, severe attacks of pain and inflammation in the joints, most often the big toe. While certain factors can predispose you to the disease, such as genetics or chronic kidney disease, others like diet, alcohol, and obesity can contribute just as profoundly.

While men are more likely to have gout than women, the risk in women can significantly increase after menopause.

Dietary Causes

Unlike other forms of arthritis, gout is caused by abnormalities in body metabolism rather than the immune system. The risk of gout is related to multiple factors—genetic, medical, and lifestyle—that together contribute to a rise in uric acid levels in the blood, a condition we refer to as hyperuricemia.

The foods we eat can play a significant role in the development of gout symptoms. This is due in large part to an organic compound found in many foods called purine. When consumed, purine is broken down by the body and converted into the waste product, uric acid. Under normal circumstances, it would be filtered out of the blood by the kidneys and expelled from the body through urine.

If uric acid is formed faster than it can be excreted from the body, it will begin to accumulate, eventually forming the crystals that cause attacks. Certain foods and beverages are common triggers for this. Among them:

• High-purine foods are considered a major risk factor for gout. These include foods like organ meats, bacon, veal, and certain types of seafood.
• Beer is especially problematic as it is made with brewer's yeast, an ingredient with an extremely high purine content. But any form of alcohol, in general, can increase risk of gout attack. 
• High-fructose beverages, including sodas and sweetened fruit drinks, can cause hyperuricemia as the concentrated sugars impair the excretion of uric acid from the kidneys.

Genetic Causes

Genetics can play a significant role in your risk of gout. Variations or mutations in the SLC2A9 and SLC22A12 genes, which are involved in excretion of uric acid into the urine, can lead to hyperuricemia and gout. 

Other genetic disorders linked to gout include:

• Hereditary fructose intolerance
• Kelley-Seegmiller syndrome
• Lesh-Nyhan syndrome
• Medullary cystic kidney disease

Medical Causes

There are certain medical conditions that can predispose you to gout. Some directly or indirectly affect renal function, while others are characterized by an abnormal inflammatory response, which some scientists believe may promote uric acid production.

Some of the more common medical risk factors include:

• Chronic kidney disease
• Congestive heart failure
• Diabetes
• Hemolytic anemia
• Hypertension (high blood pressure)
• Hypothyroidism (low thyroid function)
• Lymphoma
• Psoriasis
• Psoriatic arthritis

Other medical events are known to trigger a gout attack, including a traumatic joint injury, an infection, a recent surgery, and a crash diet (possibly through rapid changes in blood uric acid levels). 

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Medication Causes

Certain medications are associated with hyperuricemia, either because they have a diuretic effect (increasing the concentration of uric acid) or impair renal function. Most important are the diuretic medicines, such as furosemide (Lasix) or hydrochlorothiazide. Other medicines, such as levodopa (used to treat Parkinson’s disease) or niacin (vitamin B3) can also increase uric acid levels. 

Lifestyle Risk Factors

Lifestyle factors can play as much of a role in your risk of gout as the factors you can't control, such as age or sex. They may not entirely erase your risk, but they can affect how frequently and severely you experience an attack.

Obesity

Chief among these concerns is obesity. On its own, excessive body weight is associated with high uric acid levels.

According to the researchers, among people with gout, those with higher volumes of abdominal fat have a 47.4 percent risk of an attack compared to those with normal waistlines who have a 27.3 percent risk. This is irrespective of the person's body mass index (BMI), suggesting that the more fat we visibly carry, the greater our risk of symptoms.

Other Factors

From a health management perspective, many of the same factors associated with chronic diseases such as type 2 diabetes and cardiovascular disease are linked to gout. These include:

• Excess visceral fat (abdominal fat)
• High blood pressure (above 130/85 mmHg)
• High LDL ('bad") cholesterol and low HDL ("good") cholesterol
• High triglycerides
• Insulin resistance
• Regular alcohol use
• Sedentary lifestyle