A Case of The Gout

Have you ever heard that a relative has a case of "the gout" and wondered what that was all about? Perhaps you've had pain in a joint and wondered if that was gout. Either way, it's a condition that is often heard of, but not very clear exactly what exactly "gout" means. Well, today you get to put on your amateur chemist lab coat (figuratively, of course, unless you actually have one; in which case, carry on) and learn a little bit about gout.

Gout is the common term for the buildup of uric acid in the bloodstream. Over time, this can lead to painful flares, deposits of crystals in the tissue, and even joint damage in some cases. The process has lots of factors that contribute to it and people with gout may only need one factor to develop it while others have multiple factors but don't ever develop a painful flare.

You might be asking yourself "what risk factors do I have?" or "how can I prevent this?" Even more, you might be thinking "what does chemistry have to do with this?" Well, buckle up and get ready for my attempt at simplifying a very complex chemical principle.

Uric Acid

Uric acid (UA, or monosodium urate, for you scientists out there) is a byproduct of your normal body functioning. Specifically, it is created during the processing of purines--most commonly the As and Gs in your DNA molecules--for all the little witchcraft your body performs on a microscopic level to keep you alive. Normally, the enzymes needed to tinker with these molecules work perfectly (like a mini robot that performs one specific function in connecting the molecules like tinker toys). Sometimes, however, there are genetic mistakes that make the enzyme work far too quickly and make excess UA. Other times, kidneys are unable to remove it sufficiently from the blood stream, so it builds up in your blood. One more factor is diet. If you eat foods that are rich in purines, this adds yet another factor to account for. The foods you should look out for most are red meats, shellfish and other seafoods, and alcohol.

Below, I'll attempt to (sort of) describe the imbalances and how they can lead to a gout flare or be at a normal level. This is a metaphor, not an actual explanation. It's just to show a rough idea of how UA can build up in your system. The blue liquid will be UA for this example. The large drum is the level of UA in the blood. The pouring drum represents production of the UA. Finally, the spout pouring out the UA is your kidney functioning to remove the UA from the blood. The bigger the spout, the faster it filters out the UA. *(You don't have to read all my nerd explanation if you don't want to. You can just skip below--I'm not your professor, after all)

Combination 1: Normal UA production, normal UA removal from kidneys 

Unlikely to develop gout (this is your average person)

Combination 2: Excess production, above average UA removal by the kidneys

This leads to a normal level of UA, also likely to not have issues with gout

Combination 3: Excess production with normal UA removal through kidneys

Leads to excess UA buildup, will likely develop gout

Combination 4: Normal production with decreased UA removal

Builds up UA because it isn't being removed

Sorry for the slightly technical nature of the illustrations, but I learn best through diagrams, so this was how I decided to illustrate the process. In short, some people build up UA in their systems, other people are able to get rid of it fast enough to not have issues.

 If the levels of UA get high enough, the acid stops being dissolved, and just like making rock candy, the acid molecules quickly fall out of solution and form solid crystals. Table salt forms little cubes, UA forms little javelins. Just Google it, you'll see. These little buggers are very sharp and naturally jab into everything: bone, cartilage, muscle, skin, etc. The result of this whole process is that the area gets very inflamed and with inflammation comes pain.

Usually, a flare requires some sort of prescription-strength medication like Medrol, Prednisone, or indomethacin to address the inflammation. There are also other medications that shorten flares such as colchicine. These are not long term solutions. Often times a medication like allopurinol is required to stop the production of UA, so it doesn't build up.

There is one home remedy that I've used successfully with a handful of my patients. Cherry juice actually helps with mild cases of gout. I've had patients tell me that when they feel a gout attack coming on, they'll drink a bottle of cherry juice and it will stop the flare before it starts. There is actual evidence behind this, but I usually recommend a prescription as opposed to fruit juice. I hesitate to give too much weight to homeopathic remedies because people will end up treating what they think is one thing and find out too late it was something else altogether. That is why I always recommend getting evaluated by a specialist. We're trained to solve the puzzle of symptoms, let us help you out!

Note, the links I've provided today are not my websites. I simply performed a quick Google search to find a quick example, rather than spend weeks making rock candy or finding a patient with gout to use as an example. 

The illustrations, however, are all mine. Not flashy, but adequate.