Gout is caused by a buildup of uric acid in your blood. When the uric acid level in your blood becomes very high and your body is unable to excrete it in your urine, uric acid turns into microscopic crystals in your joints. These crystals that form in your trigger a reaction from the immune system, which causes pain and inflammation in the joints – resulting in what is known as a gout attack.
Uric acid, usually harmless, is a waste product that forms when the body breaks down certain types of acid known as purines. Purines are found naturally in the body, but they are also found in some foods and in alcohol. Two thirds of uric acid is produced by your kidneys. The other third is produced by your digestive system. Uric acid usually dissolves in your blood and passes through your kidneys into your urine so that it can be passed out of your body.
If you produce too much uric acid or if your body removes too little by way of urination, uric acid will build up in your body and may cause microscopic crystals to form (usually) in the joints or in surrounding tissues.
Now that we know what causes gout, it is very important to learn what factors can increase the amount of uric in your blood and, thereby increase your chances of developing gout. These risk factors are categorized into three groups:
- Lifestyle factors, such as gender, diet, and alcohol intake
- Medical factors, such as medical conditions that are known to increase the levels of uric acid in your blood and medications
- Family history
We discuss these risk factors in detail below.
Lifestyle factors that may influence your uric acid level include diet and alcohol intake.
As we already mentioned earlier, there are some foods that are naturally high in purines. To reduce your chances of developing gout or prevent a gout attack, it is recommended that you avoid these purine-rich foods. These foods include:
Alcohol also contains purines. Beer contains the highest level of purines, spirits contain a moderate level, and wine contains the lowest level. In the past it has been wrongly assumed that red wine is particularly bad, however beers are markedly worse than most other alcoholic beverages.
Medications and Medical Conditions
Certain types of medications can increase your uric acid levels, and therefore your risk of developing gout. These include:
- Low-dose aspirin – often administered to reduce the risk of blood clots
- Diuretics – used to treat high blood pressure (hypertension) or an abnormal buildup of fluid in your body
- Niacin – used to treat high cholesterol
- Chemotherapy – used to treat cancer
- Antacids such as allapurinol can actually make gout worse before improving things
Likewise, certain medical conditions may trigger gout. These include:
- High blood pressure
- Reduced kidney function
- Hyperlipidaemia – high fat and cholesterol levels
- Vascular disease – when your arteries become thickened, narrowed, or blocked
- Some forms of psoriasis – a condition that causes skin cells to reproduce too rapidly, leading to itchy, sore flaky, and crusty skin.
Gender and Family History
Gender and family history may also play a role in your chances of developing gout.
Studies have shown that gout can be hereditary and, therefore, often runs in families. As a rough estimate, approximately 20% of people with gout have a close family member who also has the condition.
Men are three to four times more likely to develop gout than women. This is because their uric acid levels rise during puberty and stay elevated in comparison to females. Gout in women usually occurs during or after the menopause. Women experience a similar, albeit somewhat smaller rise in uric acid levels, which explains why the onset of symptoms occurs later in women than it does in men.
Because of all these risk factors for gout, it can be fairly difficult to pin down the exact causes of gout as the triggers can be many and varied. One thing is obvious though — avoiding foods high in purines, keeping hydrated and exercising can help reduce the chances of developing gout and prevent a gout attack.