"What Circumstances Lead to the Development of Gout?"

Gout: An Overview

Gout is a heterogeneous disease caused by impaired purine metabolism, excessive uric acid production, or reduced excretion, leading to elevated serum uric acid levels. When patients develop hyperuricemia, failure to treat it promptly may result in the onset of gout.

Etiology

1. Impaired Purine Metabolism: Defects in certain enzymes involved in purine metabolism can affect compensatory purine metabolism, resulting in increased uric acid production or reduced renal excretion of uric acid, thereby elevating serum uric acid concentrations.

2. Excessive Uric Acid Production: Long-term consumption of purine-rich foods, such as seafood and animal viscera, as well as heavy alcohol consumption, can trigger gout attacks.

3. Reduced Excretion: Decreased tubular secretion and excretion of uric acid, leading to reduced uric acid excretion, is also a significant factor contributing to gout.

Clinical Manifestations

The acute arthritis phase is the most common initial symptom of gout, manifested as sudden pain that typically onsets at night. The affected joints and surrounding tissues exhibit redness, swelling, heat, and pain, with severe cases potentially leading to joint deformities. Recurrent attacks can result in the formation of tophus, which deposit in subcutaneous soft tissues, compressing local nerves and causing severe pain. It is recommended to maintain a balanced diet, avoiding high-purine foods like pig liver, anchovies, and sardines. Additionally, engaging in regular physical activity, controlling weight, and abstaining from alcohol and smoking can help prevent gout.