16 Nov 2014

Causes of gout and hyperuricemia

Causes of  gout and hyperuricemia
Gout is a metabolic disease where there is an increased body pool of uric acid. This will lead to deposition of mono sodium urate crystal in the joints. It causes pain in joints due to arthritis .It is a disease of middle aged to elderly men and post menopausal women.Gout  is more common in men than women with a sex ratio 5:1. Incidence  increases  with advance in age.Recently it has become more common  due to raise in metabolic syndrome, where hyperuricemia is an important component.
Definition of  Hyperuricaemia is - serum uric acid level more  than two standard deviations from the mean (420 umol/L in males, 360 umol/L in females).Increased uric acid level is  a risk factor for hypertension, renal and cardiovascular disease.

Why people develop hyperuricemia?
One third of body uric acid pool is derived from diet and two –third is produced within the body from metabolism.Uric acid is eliminated from the body through kidney(two-thirds)  and gut (one-third).Body uric acid pool  is determined by  the balance between ,synthesis within the body and elimination.Network of enzymes are involved in the synthesis of uric acid most important one is Xanthine oxidase.Though there is  a variety of causes for hyperuricemia in 90% of cases it is due to decreased elimination by kidney.Genetic factors also play important role in gout.

Causes of hyperuricemia.
  • Decreased  excretion by kidney
  • kidney failure
  • Lead toxicity (saturnine  gout)
  • Lactic acidosis from alcohol ,exercise ,starvation.It interfere with renal excretion
  • Alcohol (especially beer,that contains guanosine)
  • Drugs
  • Thiazide and loop diuretics
  • Low-dose aspirin
  • Ciclosporin
  • Pyrazinamide
  • Hypothyroidism

Increased intake
  • Red meat
  • Seafood
  • Offal

Increased uric acid production
  • Myeloproliferative and lymphoproliferative disease example  polycythemia ,leukemia
  • Psoriasis
  • High fructose intake
  • Glycogen storage disease
  • Inherited disorders  Lesch–Nyhan syndrome(HPRT mutations)
  • (mental retardation, self-mutilation and choreoathetosis)

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