Gout develops when the level of uric acid in the blood stream is higher than normal. When this happens urate crystal are deposited in and around the joints.
There are two types of gout, primary and secondary. The body eliminates uric acid from the blood naturally and most of this (66%) is done by the kidneys. In primary gout the process of elimination is slow and as a result the uric acid level in blood remains higher than normal. This is called hyperuricaemia.

In this condition the level of uric acid in the blood gradually increases over several years and during this time there are no gout symptoms. In addition it is estimated that only 5% of people with high blood level of uric acid develop gout.

Secondary gout is as a result of other diseases or factors that can elevate the level of uric acid. Often it is the case that these diseases or drugs make the body produce uric acid faster than the body can eliminate it.

Drugs that can raise uric acid level are diuretics especially thiazides,low dose aspirin,pyrazinamide and cytotoxic drugs.

Medical conditions that can trigger gout include kidney disease, myxoedema, psoriasis, lead poisoning, sarcoidosis, obesity, myeloproliferative disorders and polycythaemia.

People on very strict (almost starvation) diet can have high uric acid levels. Hyperlipidaemia is associated with high uric acid level.

Urates are eliminated mainly by the kidneys. The renal tubules are the important part of the kidneys for excretion of uric acid. So anything that can affect the efficient functioning of the renal tubules can affect the level of serum uric acid.

Dr. Phil Hariram,

Arthritis Guide