What is Gout? - Causes, Symptoms & Treatment

What is Gout? - Causes, Symptoms & Treatment
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  • 0:41 What Is Gout?
  • 1:23 Why Does Gout Occur?
  • 4:14 Clinical Signs,…
  • 5:13 Treatment of Gout
  • 6:05 Gout Fun Fact
  • 7:28 Lesson Summary
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Lesson Transcript
Instructor: Artem Cheprasov
This lesson will cover a condition known as gout as well as the physiological mechanism behind its formation. We'll cover important clinical signs, diagnostics steps, and treatments utilized for this disease.

Garbage Accumulation in the Body

Garbage being strewn about the streets of a city can cause quite a stir. Besides the massive stink that it will cause, garbage accumulation can lead to the development of disease due to a wide variety of factors. The same principle occurs in your own body, where garbage accumulation can lead to a lot of diseases, one of which will be described in this lesson. However, the garbage in this malady isn't the accumulation of banana peels people will slip on; it's actually the formation of little crystals that will slice your joints apart.

What Is Gout?

However, these crystals, unlike many other minerals found in nature, are worthless. They're truly garbage. They cause a condition called gout. This is a painful, inflammatory form of arthritis caused by urate crystal deposition in the joints. You may have heard of gout and the many risk factors involved in its development. Risk factors include alcohol consumption, being overweight, kidney disease, being a man, and having a family history of this disease. Therefore, genetic defects may play a role in causing things to go haywire during the development of gout.

Why Does Gout Occur?

While many risk factors abound, the pathway of gout formation is as follows:

In nature, there exist compounds called purines. You've probably heard of two famous purines called adenine and guanine, the molecules that help to make up things like DNA and the energy currency of your body, called ATP. Naturally, humans break down purine through a series of steps. The second-to-last step involves something known as xanthine, a purine base.

Xanthine oxidase is a type of enzyme that converts xanthine into uric acid, while uric acid is the end product of purine metabolism in humans. Uric acid, the end product of this pathway, serves no use in the human body and is basically just garbage. Normally, your body makes sure uric acid is kept at a safe level by either excreting it in urine or by recycling purines using a salvage pathway to avoid forming uric acid in the first place. When a defect in this salvage pathway or in the excretion of uric acid occurs, uric acid crystals, also known as urate crystals, begin to form instead and deposit themselves in places like your joints.

So you can liken what happens to real life. When garbage piles up in a city, the city garbage collection team picks it up and tosses it out into the local dump. Or the garbage is sent to be salvaged and recycled for reuse. Your body does this as well. But if the recycling or garbage collection facilities shut down, then the garbage will accumulate in the city streets, predisposing people to disease.

But it gets worse. Since those uric acid crystals aren't supposed to be in the joints, the body interprets them as a foreign invader and launches an inflammatory response to try and kill them. But they can't be killed because they're not alive to begin with!

So, as white blood cells, called neutrophils, move in to eat the crystals in order to try and destroy them, the sharp crystals poke holes in the cell's stomach-like structure, called a lysosome, killing the neutrophils and releasing the digestive enzymes of their stomachs into the surrounding area. Those digestive enzymes then begin to break down the joint as more inflammatory cells are recruited that also end up dying, causing a vicious cycle to continue.

Clinical Signs, Symptoms, and Diagnostics

This cycle of inflammation causes:

  • Painful, swollen, and tender joints.
  • Complications, such as kidney stones.
  • Tophi, which are masses of uric acid crystal that form in the soft tissue of people with long-standing gout.

Tophi are a pathognomonic sign of gout, meaning they are a symptom or sign of a disease that is so distinct and unique in its nature it can be used on its own to diagnose a condition. Besides looking for tophi to diagnose gout, other things we can do include running blood tests to check for hyperuricemia, or abnormally high levels of uric acid in the blood that predispose to crystal formation. This is usually not diagnostic of gout, however, so a doctor may withdraw a sample of joint fluid, called synovial fluid, to look for uric acid crystals directly in the joint instead.

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