What causes gout?

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What is gout?

Gout is a type of inflammatory arthritis caused by the accumulation of uric acid crystals in the joints. As the level of uric acid in the blood increases, it can lead to the formation known as uric acid crystallization. This condition usually develops suddenly and causes severe pain, swelling, and redness in the affected area. While gout can occur in joints such as the wrists and elbows, it most commonly affects the big toe.

Gout attacks, which can begin unexpectedly, may recur over time if left untreated. Although it is a chronic disease, effective treatment methods can significantly reduce gout symptoms. This way, it may also be possible to prevent potential future attacks.

What causes gout?

Gout occurs when the uric acid level in the blood rises above normal (hyperuricemia). Uric acid is a natural waste product formed when the body breaks down substances called purines. These purines, which are broken down into uric acid, are naturally produced by the body and are also found in certain foods.

Normally, uric acid dissolves in the blood and is eliminated through the kidneys. However, when the body produces too much uric acid or the kidneys cannot eliminate it efficiently, crystals can form in the joints. But how exactly does this happen? In other words, what causes gout?

The risk of developing gout can arise from various factors, including eating and drinking habits as well as lifestyle choices. Some factors that increase the risk of this disease include:

• A diet rich in red meat and seafood
• Frequent consumption of alcoholic beverages such as beer
• Excess weight and obesity
• High blood pressure
• Kidney diseases
• Use of certain medications such as diuretics

Is gout hereditary?

Genetics can play a role in a person’s risk of developing gout. Having a close family member with gout increases the likelihood of developing the disease. This is due to inherited differences in how the body processes uric acid and how efficiently the kidneys can excrete it. However, genetic predisposition does not necessarily mean a person will develop gout.

Even if someone has a family history of gout, lifestyle, diet, and other health factors are decisive in the disease’s onset. Maintaining a healthy diet, controlling weight, and undergoing regular health check-ups can reduce the risk even for those with a family history.

What are the symptoms of gout?

Gout symptoms can vary depending on the severity of the disease, but there are typically some distinct signs. The most characteristic symptom is sudden and severe joint pain, which often begins at night or in the early morning hours. In most cases, this pain is accompanied by swelling, redness, and warmth.

The most common symptoms of gout include:

• Severe joint pain: Often starts in the big toe but can also affect the ankle, knee, wrist, fingers, and elbows.
• Lingering discomfort: After a severe attack, the pain may subside but continue at a milder level for days or weeks.
• Inflammation and redness: The affected joint becomes swollen, tender, and warm to the touch.
• Limited range of motion: As the attack progresses, moving the affected joint normally can become difficult.

How is gout diagnosed?

To diagnose gout, the doctor first takes the patient’s medical history and examines their symptoms. The affected joint is then physically examined. The most reliable method for a definitive diagnosis is to extract fluid from the joint and analyze it.

In this procedure, fluid is taken from the inflamed joint and examined under a microscope for uric acid crystals. Blood tests can measure uric acid levels, but high levels alone are not sufficient for a gout diagnosis. Imaging methods such as X-rays, ultrasound, or dual-energy CT can be very helpful in detecting crystal deposits and ruling out other joint problems.

How is gout treated?

The goal of gout treatment is to relieve symptoms during an attack and prevent future attacks. Treatment usually involves medication, lifestyle changes, and regular follow-ups.

Main treatment methods for gout include:

• Medications for pain and inflammation control: During acute attacks, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or colchicine may be prescribed.
• Uric acid-lowering therapies: Medications such as allopurinol or febuxostat help control uric acid levels in the long term.
• Lifestyle changes: Reducing purine-rich foods, limiting alcohol, maintaining a healthy weight, and drinking enough water can decrease the frequency of attacks.
• Regular follow-up: Blood tests and check-ups help ensure uric acid levels stay within a healthy range.

What should gout patients pay attention to?

During treatment, certain changes in diet and lifestyle can help improve treatment success. Your doctor will also guide you in this regard. Below are some points to consider during this process:

Take your medication correctly and regularly

Medications are the most powerful tools for managing gout. It is important to take them as prescribed by your doctor. Stopping regular use can cause uric acid levels to rise again and increase the risk of attacks. Do not stop your uric acid-lowering medication during an attack; while the attack is treated with separate drugs, continuing your long-term medication is generally recommended.

If you are using thiazide/loop diuretics (certain “water pills”) that may trigger gout, your doctor may consider alternatives such as losartan or calcium channel blockers. Ultimately, any decision to stop or change medication should always be made with your doctor.

Diet: What to limit and what to emphasize

Diet alone is not enough to significantly lower uric acid in most people, but it can help reduce triggers and manage weight. The main goal is to limit animal purines and fructose while adopting a healthy, balanced diet.

• Limit/avoid: Organ meats, red meat, certain seafood (e.g., anchovies, sardines, mussels), alcohol (especially beer and spirits), and high-fructose drinks (sodas/syrups). Short-term excessive intake of purines or fructose can increase attack risk.
• Emphasize: Vegetables, whole grains, legumes, fruits (in controlled amounts), low-fat dairy products, and heart-healthy dietary patterns (DASH/Mediterranean style).

Water, weight, and exercise

• Adequate fluid intake supports uric acid excretion through the kidneys and reduces the risk of stones.
• Gradual, sustainable weight loss can lower both uric acid levels and attack frequency.
• Moderate-intensity exercise that does not place excessive strain on the joints can be beneficial.

Coexisting conditions and medications

Gout often coexists with conditions such as high blood pressure, diabetes, excess weight, chronic kidney disease, and high cholesterol. All of these can influence attack risk and uric acid levels. Regular check-ups to evaluate possible drug interactions and considering alternative medications when necessary are important.