Gout and Hyperuricemia
Medical Author: William C. Shiel Jr., MD, FACP, FACR
Gout & Aspirin
Medical Author: William C. Shiel Jr., MD, FACP, FACR
Many patients will read that aspirin increases the level of uric acid in the blood and that the blood level of uric acid is important in Gout. What is the relationship between the two factors? Additionally, many patients are prescribed a low dose of aspirin (75-81 mg daily) to prevent heart attacks or strokes. What should patients be told about aspirin and Gout? Will it cause Gout in them?
These questions bring up a number of important issues about Gout.
First, Gout is medical condition that is characterized by abnormally
elevated levels of uric acid in the blood, recurring attacks of joint
inflammation (arthritis), deposits of hard lumps of uric acid in and around the
joints, and decreased kidney function and kidney stones. While Gout is often
associated with an abnormally elevated blood uric acid level, it need not be.
This means that the medical condition of Gout can exist in an individual
regardless of an elevated uric acid level in that person. This even holds true
for an acute attack of gouty arthritis! Moreover, many patients with elevated
blood levels of uric acid (hyperuricemia) never develop gout.
It is, therefore, important to understand that it may not
necessarily be the level of uric acid that triggers an acute attack of gout.
Frequently, acute attacks are precipitated by a rapid change of uric acid,
either up or down. Additionally, the tendency towards developing gout seems to
be significantly influenced by the metabolism a person inherits.
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What is gout? What is hyperuricemia?
Gout is a condition that results from an overload of crystals of uric acid depositing in tissues of the body and features recurring
attacks of joint inflammation (arthritis). Chronic gout can lead to deposits of hard lumps
of uric acid in and around the joints, decreased kidney
function, and kidney stones.
Gout has the unique distinction of being one of
the most frequently recorded medical illnesses throughout
history. It is often related to an inherited abnormality in the
body's ability to process uric acid. Uric acid is a breakdown
product of purines that are part of many foods we eat. An
abnormality in handling uric acid can cause attacks of painful
arthritis (gout attack), kidney stones, and blockage of the kidney-filtering
tubules with uric-acid crystals, leading to kidney failure. On
the other hand, some patients may only develop elevated blood
uric-acid levels (hyperuricemia) without having arthritis or kidney
problems. The term "gout" commonly is used to refer to
the painful arthritis attacks.
Gouty arthritis is usually an extremely painful
attack with a rapid onset of joint inflammation. The joint inflammation is
precipitated by deposits of uric-acid crystals in the joint fluid
(synovial fluid) and joint lining (synovial lining). Intense
joint inflammation occurs as white blood cells engulf the uric-acid crystals and release chemicals of inflammation, causing pain, heat, and redness of the joint
tissues.
Who is affected by gout?
Approximately 1 million people in the United States
suffer from attacks of gout. (Did you know that none other than Benjamin Franklin had terrible gouty arthritis!) Gout is nine times more common in
men than in women. It predominantly attacks males after puberty,
with a peak age of 75. In women, gout attacks usually occur after
menopause.
While an elevated blood level of uric acid (hyperuricemia) may indicate an increased
risk of gout, the relationship between hyperuricemia and gout is
unclear. Many patients with hyperuricemia do not develop gout,
while some patients with repeated gout attacks have normal or low
blood uric-acid levels. Among the male population in the United
States, approximately 10% have hyperuricemia. However,
only a small portion of those with hyperuricemia will actually
develop gout.
Next: What are the risk factors for gouty arthritis? »
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