gout

Synonyms in a broader sense

Medical: hyperuricemia

"Zipperlein", gout attack, podagra, arthritis urica

English: gout

French: goutte

Definition of gout

Gout is a metabolic disease in which uric acid crystals are deposited. comes in the joints. Uric acid is produced in the human body, among other things during cell death and breakdown of cell components (e.g. DNA / DNA = deoxyribonucleic acid).

Also read our general article on metabolic disorders: Metabolic Disorder - What does it mean?

This leads to rheumatic complaints, so:

• Inflammation
• Swelling and
• severe pain

in the affected joints, which is why the disease is classified as rheumatic.

The thumb joints can also be affected, whereby those affected suffer from very severe pain. For more information, the editorial team recommends the following article: Pain in the wrist of the thumb

Occurrence

Gout: a well-known condition ...

In the Middle Ages, gout was seen as a punishment for splattering and excessive alcohol consumption, because mostly only people were affected who could afford a lavish diet with lots of meat and fatty fish. Famous patients were e.g. Charles V, Henry VIII or Michelangelo.

... is running up to a new top form

Today it can be observed that gout increases with the diseases of the so-called "Metabolic syndrome" occurs together, which is characterized by:

• High blood pressure (arterial hypertension)
• Diabetes (Diabetes mellitus type 2)
• Overweight (Obesity) and
• Lipid metabolism disorders (Hyper- / dyslipidemia).

As it becomes stronger, gout is also gaining importance again.

Frequency (epidemiology)

Occurrence in the population
The gout is next to the Diabetes (type 2 diabetes mellitus) one of the most common metabolic diseases in industrialized countries.
About 30 percent of men and 3 percent of women have elevated uric acid levels, and one in ten patients with elevated uric acid levels (hyperuricemia) will develop gout.
For men this is independent of age, for women the values ​​increase according to the Menopause (menopause) on.

Origin and causes

The term gout is actually a collective term for various Metabolic diseaseswhich lead to increased levels of uric acid in the blood (Hyperuricemia) and the secondary diseases that result from them.

Uric acid falls in the human body as the end product of Purine nucleotide degradation on. Purine nucleotides are part of the genetic information (DNA / DNA) in all cells of the human body. The DNS must e.g. are then broken down in our organism when old cells die, or when a lot of DNA is ingested with food (meat, especially offal, contains a lot of purines).
The end product uric acid is produced over several intermediate stages, which cannot be further utilized and is excreted via the kidneys (renally).

The uric acid content in the blood is particularly high in humans. The reason for this could be the antioxidant effect (Protective function against harmful substances) of uric acid, which may have an evolutionary advantage.
The excretion of uric acid runs close to the limit even with normal uric acid levels. If this limit is exceeded, the uric acid is no longer soluble, it is said that the uric acid precipitates and forms crystals.

To illustrate this, you can imagine that you can only add a certain amount of sugar to a warm cup of tea, otherwise you will keep a sediment.
Uric acid crystals are mainly formed in the Joints of arms and legs, especially common in the Big toe joint (the clinical picture that arises from this is called Podagra designated). The reason for this lies in the poor solubility of salts in liquids with low temperatures (as they apply in comparison between hands and feet (relatively colder) to the core of the body).
Sugar dissolves better in warm tea than in cold tea. The uric acid crystals in the joint space are recognized as foreign bodies by the immune system's defense cells and eaten, whereupon the cells die and there is a massive release of inflammatory substances from inside the cells, which in turn attract further defense cells. A vicious circle arises.

In principle, the disorders of purine breakdown that lead to gout can be divided into two groups:

1. disturbed uric acid excretion = uric acid is not excreted to a normal extent, so it accumulates in the body.
2. increased uric acid production = In the body, due to the most varied of processes, there may be an increased production of uric acid, here too it accumulates to a greater extent with normal excretion.

Primary hyperuricemia

Under primary hyperuricemia (also called primary gout) is the rise in uric acid levels as a result of hereditary metabolic defects. In the majority of cases, hyperuricemia is the primary form.

A possible cause is a polygenic (which means that several genes are involved) decrease in uric acid excretion via the kidney. The reason for this is a lack of ducts through which uric acid normally enters the urine (approx. 99% of all cases).
The Lesch-Nihan Syndrome, a very rare disease that is inherited via the X chromosome (about 1% of all cases). The genetic error means that a certain metabolically active protein (enzyme) that belongs to the purine metabolism is no longer formed. The job of the enzyme is to recycle purines into DNA. Recycling usually produces fewer purines, which the body has to break down into uric acid.

Secondary hyperuricemia

As secondary hyperuricemia (also called primary gout), on the other hand, is a rise in the uric acid level caused by a acquired disease is conditional.

Possible examples are:

• Psoriasis
• blood cancer (Leukemias)
• Anemia (hemolytic anemia)
  but also
• Chemotherapy for one tumor

lead to increased cell death? there are more DNA = purines.

Kidney disease (e.g. Kidney failure), Diabetes mellitus (diabetes), keto and lactic acidoses lead to a decrease in kidney excretion for uric acid? more purines remain in the blood).

Alcohol (by inhibiting kidney excretion), a diet rich in purine (e.g. meat and fish) and certain drugs that influence uric acid excretion (e.g. laxatives, "water tablets" (diuretics)) can promote the development of hyperuricemia.

Therapy of gout

Therapy for gout starts with you healthy eating style on. A low-purine diet is recommended as purines increase in the human body uric acid be metabolized.

In order to compensate for the increased uric acid level in the long term, the doctor prescribes medication that inhibits uric acid formation.