In spite of the agony and havoc it can cause, uric acid is a normal constituent of the human body. Ordinarily about one-third of the uric acid in our system comes from food, especially foods like those noted earlier that are rich in purines. The rest we produce ourselves through ordinary metabolism.
The body converts purines to uric acid. The level of uric acid in the blood fluctuates in response to:
- fluid intake
- overall health status
- other factors
Men normally have somewhat more uric acid than women do (although the difference begins to narrow after menopause), and in both sexes it tends to increase with advancing age.
Higher-than-normal amounts of uric acid in the blood, a condition called hyperuricemia, is quite common and only rarely warrants medical treatment. On the other hand, sustained hyperuricemia is the primary risk factor for gout. It’s safe to say that, while not all people with hyperuricemia develop gout, virtually everyone with gout is hyperuricemic.
It works this way:
These classical signs of inflammation, together with sudden and extreme pain, strongly suggest an acute attack of gout. The diagnosis is confirmed by laboratory finding of uric acid crystals in fluid taken from the affected joint.
Where Gout Strikes Most
Why is the big toe the most common site for an initial gout attack?
Perhaps because first, the extremities are a bit cooler than other parts of the body, and uric acid crystals form more readily at lower temperatures; and second, normal walking and standing subject the feet to considerable stress. Together, these factors might explain why among the places that gout attacks first are the:
Other targets, especially in untreated patients who have recurrent attacks of gout, are the:
Getting An Accurate Diagnosis
Accurate diagnosis is essential for appropriate treatment.
Without treatment, an initial acute attack of gout will run its painful course within several days or a few weeks, by which time all outward evidence of the disease disappears.
The next acute attack? - 50 or more percent of gout sufferers will have a second attack — which may not occur for months or years. Subsequent attacks, however, are likely to be more frequent, more severe, and more destructive to joints and other tissue unless the problem is treated.
Over time, uric acid crystals accumulate in the body, causing gritty, chalky deposits called tophi that are sometimes visible under the skin, particularly around joints and in the edges of the ears. Tophi may also form inside bone near the joints, in the kidneys, and in other organs and tissues, causing permanent damage. Advances in treatment, fortunately, have made this kind of chronic gout extremely rare.