Since this is a new blog, I thought it would be a good idea to write about the basics of gout.  I am often surprised about just how little some people who have had this condition for years know about this disease that effects their lives so much. The treatments for gout can get complicated, often requiring three different medications on different schedules so understanding what causes gout and the exact process of the disease is key to understanding the role of each of these medications and how to use them effectively.  If you properly treat this disease, there is no reason to ever have to suffer another painful attack.

Gout is cause by having too much uric acid in your body, a condition called hyperuricemia.  Uric acid is a natural substance in the body that is created through metabolism.  People with hyperuricemia either create too much uric acid and/or have trouble eliminating it from their body.  When levels of uric acid get high enough, this uric acid can start to crystalize.

If you have ever made sugar candies, you have seen this process first hand.  First you boil water, then you stir in a large amount of sugar and dangle a string into the water.  As the water cools, the solution becomes super saturated, meaning that there is more sugar dissolved in the water than the water can support and the sugar starts to precipitate out or crystalize, which forms the tasty candies on the string.  With gout, the same process is happening in your body but with uric acid playing the role of the sugar and your joints playing the role of the string – but there’s one other component that you won’t find in a bowl of water – your immune system.

When uric acid crystals form in your joint, lymphocytes (more commonly known as white blood cells) that are the front line troops of the body’s immune system, notice these crystals appearing in front of them and recognize that they don’t belong there.  They assume that these crystals are a invading foreign organism (germs) and attack them.  White blood cells protect the body from germs and disease by engulfing (eating) the threatening cells.  However, when they attack uric acid crystals, they don’t get a tasty meal, they get a dagger through their heart.

Uric acid crystals are long, pointy, needle like crystals that pop the white blood cell like a balloon.  In the white blood cell’s death scream it releases proteins that signal the immune system that the white blood cell has been over powered by an invader and that reinforcements should be sent in.  The immune system responds quickly, believing that there is little time to waste, and sends in more white blood cells and causes inflammation.

Unfortunately, these proteins also have an unintended consequence.  They cause the fluid in the joint to become more acidic.  Uric acid is an acid and will crystalize more readily in an acidic solution therefore, these proteins cause more crystals to form just as more white blood cells are rushing in.  Soon, there is a scene that looks something like a medieval battlefield.  Troops rushing in (white blood cells) and are quickly struck down by sharp spears (uric acid crystals) with the white blood cells streaming to their deaths.  More crystals form, more white blood cell reinforcements are called into action.   All the while, more and more inflammation is caused and this is the real cause of the pain of gout.

It’s a loop – a spiral – once the attacks starts, it becomes self reenforcing and very quickly, usually in less than 12 hours, you, well, if you are reading this you know what happens…  Agony.

The Spiral of Gout

The key to controlling gout is to interrupt this spiral – to break the loop – and that will be the topic of future blog entries.

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