Gout is caused by the formation of urate crystals in body tissues. It usually occurs in or around joints and results in a painful type of arthritis.
The urate crystals deposit in tissues when there’s too much uric acid in the blood. This chemical is created when the body breaks down substances known as purines. Too much uric acid in the blood is also known as hyperuricemia.
Gout can be caused by decreased excretion of uric acid, increased production of uric acid, or a high dietary intake of purines.
Decreased excretion of uric acid is the most common cause of gout. Uric acid is normally removed from your body by your kidneys. When this doesn’t happen efficiently, your uric acid level increases.
The cause may be hereditary, or you may have kidney problems that make you less able to remove uric acid.
Lead poisoning and certain drugs, like diuretics and immunosuppressant drugs, can cause kidney damage that may lead to uric acid retention. Uncontrolled diabetes and high blood pressure can also reduce kidney function.
Increased uric acid production can also cause gout. In most cases, the cause of increased uric acid production is unknown. It can be caused by enzyme abnormalities and can happen in conditions including:
It may also occur as a side effect of chemotherapy or radiation therapy, because of a hereditary abnormality, or due to obesity.
Purines are natural chemical components of DNA and RNA. When your body breaks them down, they turn into uric acid. Some purines are found naturally in the body. However, a diet high in purines can lead to gout.
Some foods are especially high in purines and can raise uric acid levels in the blood. These high-purine foods include:
- organ meats, such as kidneys, liver, and sweetbreads
- red meat
- oily fish, such as sardines, anchovies, and herring
- certain vegetables, including asparagus and cauliflower
In many cases, the exact cause of gout or hyperuricemia is unknown. Doctors believe it may be due to a combination of hereditary, hormonal, or dietary factors. In some cases, drug therapy or certain medical conditions may also cause gout symptoms.
Age and gender
Men are more likely than women to have symptoms of gout. Most men are diagnosed between 30 and 50 years of age. In women, the disease is most prevalent after menopause.
Gout is rare in children and younger adults.
People with blood relatives who have gout are more likely to be diagnosed with this condition themselves.
There are several medications that can increase your risk of gout. These include:
- Daily low-dose aspirin. Low-dose aspirin is commonly used to prevent heart attack and stroke.
- Thiazide diuretics. These medications are used to treat high blood pressure, congestive heart failure (CHF), and other conditions.
- Immunosuppressant drugs. Immunosuppressant drugs, such as cyclosporine (Neoral, Sandimmune), are taken after organ transplants and for some rheumatologic conditions.
- Levodopa (Sinemet). This is the preferred treatment for people with Parkinson’s disease.
- Niacin. Also known as vitamin B-3, niacin is used to increase high-density lipoproteins (HDL) in the blood.
Moderate to heavy drinking increases the risk of gout. This usually means more than two drinks per day for most men or one per day for all women or any men over 65.
Beer in particular has been implicated, and the beverage is high in purines. However, a 2014 study confirmed that wine, beer, and liquor can all cause repeated gout attacks. Learn more about the relationship between alcohol and gout.
Exposure to high levels of lead is also associated with gout.
Other health conditions
People who have the following diseases and conditions are more likely to have gout:
- high blood pressure
- high cholesterol
- kidney disease
- hemolytic anemia
Other things that may trigger a gout attack include:
- joint injury
- crash diets
- rapid lowering of uric acid levels through medication
You can decrease your chances of developing gout by watching your alcohol intake and eating a diet low in purines. Other causes of gout, such as kidney damage or a family history, are impossible to counteract.
Talk to your doctor if you’re concerned about your chances of developing gout.
They can come up with a plan to reduce your chances of developing the condition. For instance, if you have risk factors for gout (such as a particular medical condition), they may consider that before recommending certain types of drugs.
However, if you do develop gout, rest assured that the condition can be managed through a combination of medications, dietary changes, and alternative treatments.