Gouty arthritis is caused by a defect in the body's metabolism that permits the accumulation of uric acid (UA).
UA is a byproduct of the metabolism of purines, substances found in abundance in certain foods. While animals have an enzyme called uricase that further breaks down UA, human beings do not. Which is why UA builds up and deposits in areas such as joints leading to gouty arthritis (GA).
There are two ways that UA accumulates. Ninety per cent of the time it's because the body can't get rid of it fast enough through the kidneys, the normal mode of exit. Ten per cent of the time, UA accumulates because of overproduction of UA by the body.
There are three stages of GA.
The first stage is when people have elevated blood levels of UA but do not have symptoms. This phase is termed "asymptomatic hyperuricemia." The important thing to understand is that the actual level of UA in the blood will dictate the likelihood of getting gout attacks. The higher the blood UA level is above normal, the greater the likelihood for attacks. A serum UA level of 6.0 mg/dl is considered normal.
The second stage is called acute intermittent GA. What this means is that a patient will have sudden flare-ups of GA. But they will also have periods of time when they don't have these severe attacks. That doesn't mean they are disease free, because most people who have this stage of GA will still have smoldering inflammation in their joints. Attacks can occur as frequently as every few weeks but can be spaced out as long as several years. These acute attacks have a tendency to occur in joints that have been damaged from other diseases such as osteoarthritis. The attacks are extremely painful.
The final stage is advanced GA. In this stage, elevated blood UA has been present for a long time, usually ten years or longer. While acute attacks may still occur, the disease has gotten to the point where deposits of UA occur in different areas of the body including the joints, skin, and kidneys. These accumulations of UA form lumps that are called "tophi" (toe- f- eye). Patients will have chronic joint symptoms affecting multiple joints. The severe degree of inflammation as well as the presence of multiple joints being involved, often occurring in a symmetric fashion, can lead to a mistaken diagnosis of rheumatoid arthritis.
Treatment of GA will vary depending on the stage a patient presents with. Multiple effective medication, dietary, and lifestyle therapies are available.