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Things? Hyperuricemia Causes, Symptoms and Treatment

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Generality

The gotta is a disorder of purine metabolism, characterized by:

  • Elevated serum urate levels (hyperuricemia);
  • Formation of uric acid deposits in various locations (office);
  • Acute inflammatory joint attacks (monoarticolare arthritis), with urate deposits in the cartilage;
  • Kidney disease (gouty nephropathy);

Well known since ancient times and described by Hippocrates, Celsus and Galen, gout today affects approximately 0.3% of the European and North American population. Once considered the prerogative of the richest social classes (Suetonius defined it as “the disease of the lords“), is actually a disease with a strong genetic component, linked only minimally to lifestyle.
Gout is an almost exclusive prerogative of men (approximately 95% of cases) and begins, on average, between the ages of 30 and 50.
A blood test or taking a sample of fluid from the joint swelling can help confirm the diagnosis.
A change in lifestyle habits, together with adequate therapy, can keep the symptoms under control.

Hyperuricemia: what it is and uric acid values

Gout is the consequence of achronic hyperuricemia.
A subject who, after 5 days of a hypopuric diet and without taking drugs that influence uricemia (vitamin C, vitamin PP, salicylics, diuretics), has uric acid values ​​in the blood higher than:

  • 7 mg/dl if male
  • 6,5 mg/dl se donna
  • Above 9 mg/dl, the risk of gout becomes high and specific drugs are administered

Hyperuricemia is classified as:

  • Primitive: if it is not the result of an acquired disease;
  • Secondary: when it results from another type of morbid alteration or from the intake of specific drugs.

Things

What is Gout?

The GOTTA it is one of the main pathologies from uric acid deposition. The latter represents the final product of purines and is formed in the body starting from the metabolism of both endogenous (de novo synthesis) and exogenous (deriving from the diet) purines.
Various conditions can cause an increase in the serum level of uric acid, such as: alcoholism, obesity, states of high metabolic turnover (tumor lysis and myeloproliferative pathologies), some drugs (including salicylates and diuretics) and diets rich in purines (e.g. . meat).

Even rare genetic diseases can cause IPEURICEMIAwith and without urate deposition.

L’chronic hyperuricemia represents a harmful condition for the organism, as it is the pathogenetic basis for the development of monosodium urate (UMS) deposits in various organs and tissues.

If left untreated, the consequences associated with this situation can be disabling, especially when cardiovascular, renal and joint complications arise.

Gout can result fromexcessive production of uric acid and/or from decreased excretion.
In addition to an increase in uric acid, the clinical evidence of gout includes attacks of acute inflammatory arthritis with redness, swelling and pain in the joints. In more severe cases, the formation of nodules – called nodules – is observed office – due to the deposition of monosodium uric acid crystals, surrounded by an amorphous matrix.
The factors triggering arthritis attacks are alcohol abuse and excessive eating, prolonged fasting and joint trauma, as well as prolonged intense effort.

Cause

Gout causes: why does gout occur?

Gout can basically be caused by:

  1. Exalted synthesis of purines resulting in hyperproduction of uric acid;
  2. Decreased renal excretion of uric acid*.

* Purines are nitrogenous substances that enter the composition of DNA. They can be endogenous (produced by the body's metabolism) or exogenous (result from the degradation of foods). Their catabolism gives rise to uric acid, whose persistent increase in the plasma in turn gives rise to gout.

The first condition (1) is often hereditary and can however be aggravated by an increased introduction of purine compounds in the diet. In the second case (2) hyperuricemia is due to the decreased efficiency of the kidney in eliminating uric acid.
Traditionally, the onset of gout is attributed to excessive food intake. Although this factor, together with alcoholism, a sedentary lifestyle and the abuse of certain drugs, is nevertheless predisposing, its contribution is generally marginal.

Gout symptoms

Gout: how does it manifest itself?

The patient suffering from gout complains of intermittent joint pain (monoarticolare arthritis), generally associated with swelling, erythema and heat. The painful episodes mainly involve the joints of the hands and feet and, in approximately 90% of cases, the metatarsophalangeal joint of the big toe is primarily affected.
In chronic forms, nodules of variable size may appear office. These uric acid deposits initially form around the interphalangeal joints and the metacarpal and/or metatarsophalangeal joints. Subsequently they also appear extra-articularly, such as in the Achilles tendon and in the external part of the ear. Their color, initially salmon-pink, then becomes yellowish-white.
Gout also facilitates the formation of urinary stones e lithiasis to the point of compromising, in an advanced stage, the entire renal function.

Gout: Clinical Features

  • Involvement of one joint at a time (monarticular arthritis), which often originates from the big toe joint;
  • Sudden onset;
  • The affected joint appears warm, red and shiny;
  • Excruciating pain;
  • Possible malaise and fever;
  • Recurrent attacks involving other joints, possibly lasting about a week;
  • Subcutaneous formation of gouty tophus, nodules that collect uric acid crystals.

To know more:
Gout symptoms

Diagnosis

Gout tests: how is uricemia detected?

The diagnosis of chronic hyperuricemia with urate deposits (gout) should be suspected in the presence of factors that favor increased production and/or reduced excretion of uric acid.
The evaluation includes:

  • Medical history: involves the collection of information relating to uric acid levels resulting from previous tests, presence of concomitant pathologies, family history, use of drugs, foods and drinks.
  • Physical examination: should look for evidence of arthritis with redness, swelling and pain in the joints; the attacks begin by mainly affecting the big toe, with subsequent extension to other parts of the body, such as ankles, knees, wrists and elbows, causing burning and redness.
  • Laboratory analysis (uricemia): Hyperuricemia is the major risk factor for gout and can also be used as a diagnostic marker, although some gout patients demonstrate normal serum uric acid concentrations.

In addition to these investigations, the doctor may indicate the execution of aarthrocentesis to search for the presence of crystals and a x-ray of the joints involved looking for deposits or signs of joint pain.

To know more:
Uricemia and Uric Acid

Treatment

Gout therapy is based on the control of uric acid metabolism.
In case of an acute attack of monoarticular arthritis, it is best to immobilize the joint by placing it at rest and discovering the painful area.

Medicines

Under medical supervision you can also take:

In case of gout, the intake of some drugs must be suspended, such as certain diuretics, cortisone, aspirin and derivatives. On the other hand, chronic hyperuricemia must be treated with medicines capable of inhibiting the synthesis of uric acid (i.e. allopurinol) or promote their elimination (uricosuric drugs: probenecid or sulfinpyrazone). The administration of these drugs should never be started during an acute episode of gout.

What foods cause gout? Diet and lifestyle

The exaggerated intake of purines with food is an extremely rare but still possible cause, especially in predisposed subjects. For this reason, pharmacological therapy is accompanied by dietary therapy which involveselimination of foods rich in purines and alcoholcombined with caloric moderation necessary to promote weight loss.
In case of gout it is also essential a adequate supply of waterin order to prevent the formation of kidney stones.

To know more:
Gout Remedies: How to Cure Gout?

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