Synonyms in a broader sense
Medical: Hyperuricemia “Zipperlein”, attack of gout, Podagra, arthritis urica
Definition Gout
Gout is a metabolic disorder in which uric acid crystals are deposited mainly in the joints. Uric acid is produced in the human body, among other things, during cell death and the breakdown of cell components (e.g. the DNADNS = deoxyribonucleic acid). This leads to rheumatic complaints, i.e. : in the joints affected, which is why the disease is classified as rheumatic.
The thumb end joints can also be affected by this, whereby those affected suffer from very severe pain. For the receipt of further information the editorships recommend the following article: Pain in the thumb end joint
- Inflammations
- Swellings and
- Severe pain
Gout: A well-known disease… In the Middle Ages, gout was considered a punishment for gluttony and excessive alcohol consumption, because it usually only affected people who could afford a rich diet with lots of meat and fatty fish. Famous patients were for example Charles V, Henry VIII or Michelangelo… Today, it can be observed that gout is more frequently associated with the diseases of the so-called “metabolic syndrome“, which is a disease that can be transmitted through the body: With its increasing strength, the disease gout is also gaining importance again.
- High blood pressure (arterial hypertension)
- Diabetes mellitus type 2
- Overweight (obesity) and
- Fat metabolism disorders (hyper-/dyslipidemia).
Frequency (Epidemiology)
Occurrence in the populationGout is one of the most common metabolic diseases in industrialized countries, along with diabetes mellitus type 2. 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 in the blood (hyperuricemia) develops gout. In men this is independent of age, in women the values increase after the menopause.
Origin and causes
The term gout is actually a collective term for various metabolic diseases that lead to an increased uric acid level in the blood (hyperuricemia) and the secondary diseases that result from this. Uric acid accumulates in the human body as an end product of the purine nucleotide degradation. Purine nucleotides are part of the genetic information (DNSDNA) in all cells of the human body.
The DNA must be broken down in our organism, for example, when old cells die or when a lot of DNA is taken in with food (meat, especially offal, contains many purines). The final product, uric acid, is produced in several intermediate stages, which cannot be further utilized and is excreted via the kidneys (renal). In humans, the proportion of uric acid in the blood is particularly high.
The reason for this could be the antioxidative effect (protective function against harmful substances) of uric acid, which possibly has an evolutionary advantage. The excretion of uric acid therefore runs close to the limit even at normal uric acid levels. If this limit is exceeded, the uric acid is no longer soluble, it is said to precipitate and form crystals.
To illustrate this, one can imagine that in a warm cup of tea one can also give only a certain amount of sugar, otherwise one keeps a sediment. Crystals of uric acid are formed in the joints of arms and legs, especially in the metatarsophalangeal joint of the big toe (the clinical picture which arises from this is called podagra). The reason for this is the poorer solubility of salts in liquids with low temperatures (as compared to the hands and feet (relatively colder) to the body core).
Sugar dissolves better in warm tea than in cold. The uric acid crystals in the joint space are recognized as foreign bodies and eaten by the immune system‘s defense cells, whereupon the cells die and a massive release of inflammatory substances from inside the cells occurs, which in turn attract further defense cells. A vicious circle develops.
In principle, the disorders of purine breakdown that lead to gout can be divided into two groups:
- Disturbed uric acid excretion = the uric acid is not excreted in normal measure, therefore it accumulates in the body.
- Increased uric acid formation = in the body, due to various processes, an increased production of uric acid can occur, also here it accumulates more during normal excretion.
Primary hyperuricemia (also called primary gout) is the increase in uric acid levels as a result of hereditary metabolic defects. In the majority of cases, hyperuricemia is the primary form. Possible cause is a polygenic (i.e. several genes are involved) reduction of uric acid excretion via the kidney.
The reason for this is a lack of channels through which uric acid normally enters the urine (approx. 99% of all cases). Lesch-Nihan syndrome, a very rare disease inherited via the X chromosome (approx.
1% of all cases). The genetic defect leads to the fact that a certain metabolically active protein (enzyme), which belongs to the purine metabolism, is no longer produced. The task of the enzyme is to recycle purines to DNA.
Recycling normally results in fewer purines, which the body has to break down into uric acid. Secondary hyperuricemia (also called primary gout), on the other hand, is an increase in uric acid levels caused by an acquired disease. Possible examples are: lead to increased cell death ?
increased DNA = purines are produced. Kidney diseases (e.g. kidney failure), diabetes mellitus (diabetes), keto and lactic acidosis lead to a reduction in the renal excretion of uric acid ? increased purines remain in the blood).
Alcohol (by inhibiting renal excretion), a diet rich in purines (e.g. meat and fish) and certain drugs that influence uric acid excretion (e.g. laxatives, “water tablets” (diuretics)) can also promote the development of hyperuricemia.
- Psoriasis
- Blood cancer (leukemia)
- Anaemia (haemolytic anaemia) but also
- Chemotherapy for a tumor
