Gout – causes, symptoms, diagnosis, treatment, pathology

Gout is an inflammatory disease in which monosodium
urate crystals deposit into a joint, making it red, hot, tender and swollen within hours. When this happens, it’s called a gouty attack. The underlying cause is hyperuricemia—too
much uric acid in the blood, which results in the formation of sharp, needle-like crystals,
in areas with slow blood flow like the joints and the kidney tubules. Over time, repeated gouty attacks can cause
destruction of the joint tissue which results in arthritis. To understand where the uric acid comes from,
let’s start with purines, which, together with pyrimidines, are nature’s most common
nitrogen-containing heterocycles. A heterocycle being any molecular ring or
cycle with different types of atoms. Purines, as well as pyrimidines, are key components
of nucleic acids like DNA and RNA, and when cells, along with the nucleic acids in those
cells, are broken down throughout the body, those purines are converted into uric acid—a
molecule that can be filtered out of the blood and excreted in the urine. Uric acid has limited solubility in body fluids,
though. Hyperuricemia occurs when levels of uric acid
exceed the rate of its solubility, which is about 6.8mg/dL. At a physiologic pH of about 7.4, uric acid
loses a proton and becomes a urate ion, which then binds sodium and forms monosodium urate
crystals. These crystals can form as a result of increased
consumption of purines, like from consuming purine-rich foods like shellfish, anchovies,
red meat or organ meat. Also, though, they can result from increased
production of purines, for example high-fructose corn syrup containing beverages could contribute
to the formation of uric acid by increasing purine synthesis. Another way crystals could form is from decreased
clearance of uric acid, which can result from dehydration from not drinking enough water
or from consumption of alcoholic beverages, both of allowing uric acid to precipitate
out. Regularly eating these kinds of foods can
also lead to obesity and diabetes, both of which are risk-factors for gout. Hyperuricemia can also develop as a result
of chemotherapy or radiation treatment, since cells die at a faster-than-normal rate. Also, some individuals have a genetic predisposition
to overproduction of uric acid while others with chronic kidney disease may be unable
to excrete the uric acid. Finally, there are some medications like thiazide
diuretics and aspirin which can also increase the levels of uric acid and therefore the
risk of gout. Now gout most often affects the first metatarsal
joint of the foot—or the base of the big toe, and when it does, this condition is called
podagra. Classically in podagra, a person will wake
up from sleep feeling like their big toe is on fire; even the weight of the sheets can
be painful. The pain is most severe in the hours immediately
following the attack and then generally lessens over time, but that discomfort and swelling
can last for days or weeks. Gout can affect other joints as well like
those in the ankles, knees, wrists, and elbows. This inflammation and local pain’s ultimately
caused by white blood cells, or leukocytes, which migrate to the site to help eliminate
uric acid and release proinflammatory chemicals, including cytokines. Treatment of a gouty attack is typically focused
on decreasing the pain and swelling, most often with nonsteroidal anti-inflammatory
medications, or NSAIDS, like ibuprofen or naproxen sodium, but occasionally with corticosteroids
as well. Colchicine which has anti-inflammatory effects
by inhibiting white blood cell migration has also been used for a long time to treat gouty
attacks. To treat the underlying cause of increased
uric acid, though, it’s important to modify the diet, doing things like staying well hydrated
(with water), reducing or eliminating soda, alcohol, red meat, and seafood, and staying
active to ward off obesity. There are also medications that help to decrease
uric acid levels, which include xanthine oxidase inhibitors like allopurinol. Xanthine oxidase is an enzyme involved in
the breakdown of purines to uric acid, so inhibiting this enzyme results in less uric
acid production. Uricosuric medications, like probenecid, increase
excretion of uric acid by the kidneys. Over time, repeated gouty attacks can develop
into chronic gout, which is a type of arthritis with joint tissue destruction and permanent
joint deformity. Chronic gout can eventually lead to permanent
deposits of urate crystals—called tophi, which form along the bones just beneath the
skin. Individuals with chronic gout are also at
an increased risk for developing kidney stones made of uric acid, as well as urate nephropathy,
which is when urate crystals deposit in the interstitium of the kidney. Okay, as a quick recap, gout is a type of
inflammatory disease that typically affects the first metatarsal joint, which is the base
of the big toe, where uric acid precipitates to form monosodium urate crystals, which deposit
in the joint lead to inflammation and pain. Thanks for watching, you can help support
us by donating on patreon, or subscribing to our channel, or telling your friends about
us on social media.

100 comments

  1. My mom had been to doctor this evening who said that she has the Gout. I searched for gout and this video has really helped me understand what she's facing and the exact symptoms described in this video matched her situation. Thank-you for making such wonderful video. It's not only helping medical students, but also to normal people who are completely unknown about these problems and these animated short videos help us understand at best!

  2. My doc thinks I have gout and i am only 32 I hope this shit is curable because the pain is exruciating and he has put me on a lot of meds but if this is gout can I get rid of it I don;t want this shit coming back I want the little crystal things gone.

  3. I had Gout really quick
    Just when I.thought. I Had dietary.control
    . It flared up really fast and snapped the tendon.from.my wedding.good ring. Toe..
    Now I can't. Extend.it

    I keeep catching.it on low.lying.objects.

    STAY HYDRATED. And use nsaids. As soon.as possible to avoid using more devastating drugs..

  4. For Myself..
    I switched BEER for Cider…
    Blessed relief.
    Switch red.meat for White

    Drink.Many Waters.

    Only eat Lobster, prawns or blue cheese if you are accepting the agony over the next 6 days

  5. Pro Life Tip (yes I know)
    If you have NEVER had Kidney Stones..
    But have had Gout

    Do everything possible to stop gouty attacks

    Imagine the pain.in your foot…
    .
    IN YOUR.PISS PIPE OR INTERNAL.ORGANS!

    Avoid.kidney.stones as.if.you were.avoiding. Disembowellment
    At least being murdered by torture will end

    KIDNEY STONES will.cause you to wish for death

  6. My father just came back from a 2 week trip overseas and was diagnosed with the Gout after experiencing severe pain on his foot during his time there and when he got back. This was the first time he received such pain and I'm starting to worry about his condition because it's been one month since he came back and no improvements have been made. He's been avoiding any kinds of meats (including what was mentioned in the video) as well as staying hydrated and doing regular exercise. Could this mean that he may be in the stage of Chronic gout? He is in his 50s as well, and so I'm starting to think that his age might also be playing the part.

  7. Your videos are amazing, such a great help for medical students like me in our final exams, and this one is no exception! Thank you so much for what you guys do, I have already shared your channel with my classmates and we all seem to think the same.

  8. I'm 24 years old have been suffering from gout for three days. Desperately painful. Maybe it's time for me to change my lifestyle.. Thank you for this video!

  9. Hi. Has anyone these symptoms? Sometimes light but sometimes very paintfull hand fingers (just in my hands), redness on joints, mostly one sometimes two or very rarely three fingers affected, mostly in one hand sometimes two together, not symetrical. If the pain severe the finger curling and can't touch it. Dr can not decide if this's gout or not, uric acid level normal. according to x-ray image report: calstic (something like that) fluid accumulation in joints.

  10. Why is cold laser therapy the best way to treat arthritis? https://healthcaremarts.com/blogs/healthcare-center/laser-therapy-for-arthritis

  11. 5 Home Remedies For Gout:

    Eat some cherries
    Drink plenty of water
    Eat low-fat dairy
    Try some vitamin C
    Add these probiotics to your diet

  12. Is it okay if I follow your flow and use this for me to make ppt in Korean? And show students in Korea? Or on YouTube in Korea?

  13. You forgot mentioning that you should not take Alopurinol or any other medication that decreases Uric acid during an Acute gout attack, giving it can worsen the attack. And if the patient is already on alopurinol, you should not increase the dose or take it out. Love your videos!

  14. I have severe pain in my left big toe joint. My blood test showed my uric acid level is normal.
    It is so painful and swollen.
    I have to take naproxin 2×500g a day or the pain comes back quickly.
    Could you please tell me what to do.

  15. how could Asprin be a treatment and a risk factor at the same time ???
    >>> I think it is a dose related thing 🙂

  16. The best video on this subject I have seen. Concise. Great job. Wish I could give more that one thumbs up.

  17. Great video … can a burning sensation under the feet and lower back pain be associated with gout???

  18. well, i have known many, many people with gout. The best cure (when possible, i.e. when the nervous system is strong) is fasting. In many people I have known, it was the definitive solution.
    I'd love to see s video on the biochemistry of fasting, though, of course, the Big Pharma may not like it at all.

  19. Dark cherry juice (syrup) from a NATURAL health care store or straight dark cherries works to eliminate an attack QUICKLY.
    Also NO ALCOHOL (especially BEER due to the YEAST in it)
    No donuts/bagels/yeast type stuff.
    SCREW BIG PHARMA.

  20. I have disintegrating disc`s in my back, & and allot of neck pain. Arthritis can also be a problem I`ve got. Imake use of this arthritis treatment method “Rοngοdο Ruzο” (Google it) on my neck, back and sides of my body, and the pain disappears. I can function for the day. With assistance from proper diet and also prevention of inflammation-causing food, your condition will enhance a lot. .

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