Managing Hyperuricemia and Gout

Gout is an ancient and well-known disease that has been around for ages, historically known as the “Disease of Kings” due to its association with the consumption of creamy and rich foods. There is an extensive list of food groups that some individuals are more sensitive to, including red meat, alcoholic beverages and wine, shellfish and seafood, and even spinach. 

Gout attacks are infamous for attacking areas surrounding the big toe joints, likely related to low-grade temperatures along with these peripheral locations, that make it easier for uric acid crystals to precipitate and deposit.

How Does A Gout Attack Happen?

This disease occurs when the body’s metabolic breakdown of foods (that are considered to be purine-rich) are broken down in the bloodstream by several special proteins called enzymes. A key enzyme known as xanthene oxidase is one of the targets used to treat gout with medications. This enzyme helps to form the metabolic byproduct of uric acid.  

When there is overconsumption, or under secretion due to poor kidney function, and there are elevated levels of uric acid within the bloodstream, it will reach a certain threshold and cause the uric acid crystals to precipitate and deposit in the joints, articulations, and bones in the body.  

The body’s own immune system recognizes these deposits as foreign and initiates a sophisticated and destructive cascade of events attempting to break down and rid the body of these crystals. This inflammatory process mediated by our body’s own immune system is what frequently causes the severe pain that is associated with an acute gout attack. Patients will often complain that the area is so painful, that even placing a bed sheet on the affected area can cause debilitating pain.

Where Does Uric Acid Deposit?

It was once thought that uric acid only deposits in the joints, bones, and articulations. However, recent advances have found that uric acid also deposits on various vital organs throughout the entire body. This includes the eyes, skin, heart, liver, pancreas, kidneys, and thyroid- the latter organ is associated with causing the person to become immunocompromised. These deposits of uric acid, if uncontrolled, can form distinctive chalky white masses, called tophi, that become visible to the naked eye. Frequently, these masses can be seen in the ear lobes, elbows, knees, and feet, for example.

What Happens When An Acute Attack Is Over And How Do I Know If It Will Come Back Again?

It was previously thought that once an acute gout attack has resolved, the gout crisis is over. However, the microscopic and sub-threshold levels of precipitation can continue to cause asymptomatic damage to neighboring tissue all over the body. Being aware of the foods that one eats and lifestyle one leads, and possibly having to take medications orally, can significantly decrease the chances of gout coming back again.

What Is The Appropriate Range Uric Acid Levels Should Be?

Another misconception is that high levels of uric acid were once thought to be above 6.5mg/dl. However, recent studies have shown that to prevent long-term deterioration and breakdown of the effects of residual uric acid crystals deposited all over the body, target ranges for maintenance purposes have shown that a proper range is anywhere from 3-4.5mg/dl, at which uric acid crystals can actually be dissolved. 

This range can be achieved by diet, lifestyle changes, and urate-lowering agents. Talk to your podiatrist about what these agents are and how they can be used to not only get past an acute gouty attack but prevent it from coming back.

For more information on gout please come visit us at Certified Foot & Ankle specialists as we’ll be happy to answer any of your questions.

By Dr. Felipe Peterson D.P.M.