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 disease that results from an overload of uric acid in the body. This overload of uric acid leads to the formation of tiny crystals of urate that
deposit in tissues of the body, especially the joints. When crystals form in the joints it causes recurring attacks of joint
inflammation (arthritis). Chronic gout can also lead to deposits of hard lumps of
uric acid in and around the joints and may cause joint destruction, 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 people
may only develop elevated blood uric acid levels (hyperuricemia) without having
arthritis or kidney problems. The term gout refers the disease that is caused
by an overload of uric acid in the body, resulting in painful arthritic attacks
and deposits of lumps of uric acid crystals in body tissues.
Gouty arthritis
is typically 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 chemical messengers of inflammation are released, causing pain,
heat, and redness of the joint tissues.
Who is affected by gout?
Approximately 5 million people in the United States suffer from 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 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.
In fact, the blood level of uric acid often lowers during an acute attack of
gout. 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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