Gout: Inflammation and your joints

Inflammation is a key component of arthritis and other chronic joint diseases. Gout, a painful and potentially debilitating form of inflammatory arthritis, develops when tiny, needle-shaped crystals of uric acid (a biological waste product) accumulate in the joints. The presence of these uric acid crystals triggers the release of cytokines, and these inflammatory messengers attract neutrophils and other white blood cells to the scene. Gout usually affects one joint at a time, most often the big toe, but sometimes it occurs in a knee, ankle, wrist, foot, or finger.

Early on, gout flare-ups tend to be intermittent. If gout persists for a long time, the joint pain can be ongoing and mimic other types of arthritis. After several years, uric acid crystals may collect in the joints or tendons. They can also collect under the skin, forming whitish deposits. They are called tophi, lumps of tissue the form under the skin of fingers, knuckles, and elsewhere.

Most people with gout make too much uric acid. Often they have a family history of the disease, are overweight and have high blood pressure, high cholesterol, or diabetes. High protein diets, especially those rich in organ foods such as liver, kidney, and sweetbreads can raise uric acids levels and increase the chance of gouty attacks. Some people develop gout because their kidneys excrete too little uric acid.

In addition, obesity, sudden weight gain, or alcohol use can elevate uric acid levels. Some medications, particularly diuretics, also can boost levels of uric acids.