Gout Signs and Symptoms

• Gout is a condition wherein there is increased urate in the body, also called hyperuricemia, that leads to deposition of monosodium urate monohydrate crystals in various tissues (eg joints, connective tissue, kidney)

• Hyperuricemia is a necessary precondition for the development of monosodium urate monohydrate crystal deposition but this has to be distinguished from gout, the clinical syndrome
• Results in acute and chronic inflammation associated with changes in articular and periarticular structures

Causes of Hyperuricemia

• Excessive uric acid production
  • Inherited enzyme defects (eg hypoxanthine-guanine phosphoribosyl transferase deficiency, phosphoribosyl pyrophosphate synthetase overactivity, glycogen storage diseases, fructose-1-phosphate aldolase deficiency, myoadenylate deaminase deficiency, carnitine palmitoyltransferase II deficiency)
  • Clinical disorders (eg myeloproliferative and lymphoproliferative disorders, malignancies, psoriasis, Down syndrome)
  • Induced by diet, drugs, or toxins (eg Ethanol, excessive purine in diet, fructose, vitamin B12 deficiency, Nicotinic acid, cytotoxic drugs, Warfarin)
• Decreased renal clearance
  • Genetic disorders such as medullary cystic kidney disease, familial juvenile hyperuricemic nephropathy and uric acid transportasome mutations
  • Chronic renal insufficiency, volume depletion (eg heart failure, volume loss), obesity, diabetic or starvation ketoacidosis, lactic acidosis, hyperparathyroidism, hypothyroidism, sarcoidosis
  • Induced by diet or drugs (eg Aspirin, diuretics, Ciclosporin, Tacrolimus, Ethambutol, Pyrazinamide, Ethanol, Levodopa)
  • Saturnine gout is a rare form of gout due to chronic lead exposure
    • Commonly seen in plumbers and those exposed to lead-based paints

• It is the most common inflammatory arthritis in men
• In US and Europe, the estimated prevalence of gout is 3% of adults
• Prevalence of gout in the Asia-Pacific region varies
  • Ethnic groups in China and Malaysia (eg Malays, Tamils) were found to have higher uric levels as compared to the Japanese and Thai
  • Taiwan is one of the countries in the world with the highest prevalence of gout

Risk factors for gout and associated comorbidity should be assessed

Risk Factors Associated with Gout

• Hyperuricemia
  • Single most important risk factor for developing gout
• Male sex
• Menopausal women
• Age
• Purine-rich diet (eg meat, seafood)
• Alcohol intake
• Drug use (eg diuretics, low-dose Aspirin, Ciclosporin)
• Lead exposure
• Obesity
• Renal insufficiency

Metabolic Abnormalities/Comorbidities Associated with Gout

• Hypertension
• Obesity
• Dyslipidemia
• Hyperglycemia and insulin resistance
• Coronary artery disease
• Type 2 diabetes mellitus
• Renal insufficiency
• Metabolic syndrome
• Kidney stone