Summary about Gout
Gout is a disease in which the joints can be greatly affected, especially those in the distal
region of the body (feet and hands). It consists of the accumulation of monosodium urate
crystals in the synovial fluid, mainly because the concentrations in blood increase, passing
the joints and forming what is known as tophi, a state in which the joints can be affected
(more commonly in the joints of the feet and ankles), this mainly carried out by the action
of the macrophages, which by endocytosis internalize large quantities of free monosodium
urate crystals, which also leads to the expression of inflammatory processes where
interleukin 1β participates, when this occurs the joints can become inflamed, perceiving
very high pain that sometimes stops by itself, redness or difficulty moving the affected
joints; however, not all those who suffer from gout come to present these signs that
indicate the presence of the disease, therefore to diagnose it the most effective methods
are the performance of an ultrasonography or a dual energy calculating tomography, with
which it is possible to evidence certain abnormalities in the affected parts.
For there to be an increase in the levels of monosodium urate, three main possibilities have
been described; the first is overproduction by the liver, the second is underexcretion by the
kidney and gut, and the third is an increase in reabsorption. For monosodium urate to
crystallize, it must have a blood concentration equal to or greater than 6.8 mg / dL;
however, since the temperature in the extremities is lower than in the center of the body,
the urate could crystallize at a concentration of just 6.0 mg / dL; This occurs because when
lowering the temperature, the dissolution capacity of a liquid also lowers, it is also noted
that the pH also influences.
Some factors that are related to greater chances of developing gout can be:
1) Genetics: Being male, having a history with relatives who have had gout and the
variation in genes that alter the amounts in which monosodium urate is secreted
and reabsorbed (SLC2A9, ABCG2, SLC17A1 / SLC17A3 and GCKR).
2) Medications: Some medications that may be involved with the development of gout
are diuretics, cyclosporine, angiotensin-converting enzyme inhibitors,
pyrazinamide, β blockers, among others.
3) Diet: Factors from the diet can also be seen, some foods that increase the risk are
red meat, seafood, beer and sugary drinks.
4) Other important factors involved in gout disease are advanced age, menopause,
chronic kidney disease, obesity, hypertension, hyperlipidemia,
hypertriglyceridemia, obstructive sleep apnea, among others.
The best method at the moment to diagnose gout is the confirmation of the presence of
monosodium urate crystals by means of polarizing light microscopy, where the
aforementioned crystals are seen as small yellow needles of only about 1 to 20 μm; to treat
these pathologies, what is sought is to reduce urate levels, primarily with the prevention
