Understanding Gout and Its Impact

Overview of Gout

• Gout is a type of inflammatory arthritis caused by the deposition of serum uric acid around joints and tissues.
• It is characterized by excruciating pain, inflammation, and can greatly affect quality of life.
• Gout can have long periods of being 'pain-free' punctuated by acute 'gout flare-ups'.

Symptoms and Complications

• Symptoms include joint pain, swelling, redness during gout flares.
• Untreated gout can lead to permanent joint damage forming tophi, which are urate crystal deposits.
• Severe gout is linked to renal disease or insufficiency.

Prevalence

• Most common inflammatory arthritis in men, with certain populations (Taiwanese Aboriginals, Maori, Pacific Islanders) showing a prevalence of over 10%.
• Global prevalence of gout is increasing, having more than doubled in the last two decades.
• In Australia, gout prevalence is 6.8%, predominantly in men, with indigenous men at greater risk.
• The annual economic cost of gout in Australia was AU$203 million in 2019.

Pathophysiology and Aetiology

• Gout results from dysregulated purine metabolism leading to hyperuricaemia, characterized by uric acid levels above 0.42 mmol/L.
• Hyperuricaemia can stem from overproduction of uric acid or underexcretion, often exacerbated by kidney function decline.
• Affected individuals may experience increased uric acid concentrations due to excessive cell turnover (e.g., chemotherapy patients) or a purine-rich diet.

Risk Factors

• Key risk factors include:
  • Hyperuricaemia
  • Male gender
  • Older age
  • Overweight
  • Family history of gout
  • Renal impairment
  • High-purine diet (e.g., beer, meat, shellfish)
  • Use of diuretics (e.g., loop/thiazide diuretics)
• Men are more susceptible due to naturally higher uric acid levels; estrogen in women promotes uric acid clearance, decreasing with age.

Uric Acid Reference Ranges

• Female uric acid levels: 0.15-0.40 mmol/L
• Male uric acid levels: 0.20-0.45 mmol/L

Conclusion

• The concentration of urate in the body depends on dietary purine intake, endogenous purine synthesis, and effective renal/gut excretion.
• Increasing purine synthesis or reduced urate excretion raises the risk of developing gout.

This quiz explores gout, an inflammatory arthritis characterized by the deposition of uric acid crystals in joints, leading to intense pain and inflammation. Participants will learn about the causes, symptoms, and effects of gout on quality of life, as well as its intermittent nature. Gain insight into managing and understanding this painful condition.