Gouty arthritis is caused when the body’s metabolism allows for the accumulation of uric acids (UA). UA is a byproduct from the metabolism of purines. These substances are abundant in certain foods. UA is broken down by an enzyme called uricase in animals, but not by humans. This is why UA builds-up and deposits in joints, leading to gouty arthritis (GA). There are two ways UA can accumulate. Ninety percent of the time, UA accumulates because the body is unable to eliminate it quickly enough through the kidneys. This is the normal exit route.
Uric Acid
Overproduction of UA by our bodies causes ten percent of UA to accumulate. There are three stages to GA. The first stage is when someone has elevated blood levels of UA, but does not have symptoms. This stage is called “asymptomatic hyperuricemia”. It is important to remember that the actual blood UA level will determine the likelihood of getting gout attacks. An attack is more likely if the blood UA level exceeds the normal. Normal is a serum UA level of 6.0 mg/dl.
Acute intermittent GA is the second stage. This means that patients will experience sudden flare-ups. They will also experience periods when they don’t have severe attacks. However, this doesn’t mean that they are immune to disease. Most people with this stage of GA will still experience smoldering inflammation in the joints. Attacks can occur every few weeks, but they can also be spread out over several years.
Joints
These acute attacks tend to occur in joints that are damaged by other diseases, such as osteoarthritis. These attacks can be extremely painful. Advanced GA is the final stage. Advanced GA is the final stage. In this stage, elevated blood levels of UA have been present for a long period of time, often ten years or more. Although acute attacks can still occur, the disease has progressed to the point that UA deposits are found in various parts of the body, including the joints, skin and kidneys.
Tophi (toe-f-eye) is a term for UA accumulations that form lumps. Multiple joints may be affected by chronic joint symptoms. A misdiagnosis of rheumatoidarthritis can be made if there is severe inflammation and multiple joints involved. The stage of the patient’s GA will determine the treatment options. There are many effective medications, lifestyle and dietary therapies available.