Genetics Behind the Etiology of Gout

Disclaimer: This article is for informational purposes only and is not intended to diagnose any conditions. LifeDNA does not provide diagnostic services for any conditions mentioned in this or any other article.

What Is Gout?

Gout is a serious form of arthritis. It is known as a sudden and severe inflammation in the joints caused when uric acid levels in the bloodstream are high, leading to the formation of sharp urate crystals within the joints. If this is not addressed, gout can result in chronic pain and joint damage that could also lead to compromising renal health.

Gout mostly affects men, especially after age 40, and post-menopausal women when they lose estrogen’s protective effects. It commonly targets the big toe joint but can also impact knees, ankles, hands, wrists, and elbows. A deeper understanding of the different types of gout, its risk factors, and available treatment options are important for effective management and prevention of gout attacks.

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Types of Gout

Gout comes in two main types: primary gout and secondary gout. Primary gout refers to elevated levels of uric acid due to extrinsic factors such as too much consumption of alcohol or sugary beverages and food items that are high in purine. Secondary gout is linked to underlying health issues like chronic kidney disease or long-term use of certain medications that affect the kidneys’ function in filtering excess uric acid and excretion through urine.

Phases of Gout

Asymptomatic Hyperuricemia: At first, your body starts building up uric acid in your blood. It doesn’t cause any symptoms right away, so you might not even know it’s happening. But it’s important to make some lifestyle changes to keep those urate levels in check.
Acute Gout: When uric acid levels get too high, it can form crystals around your joints, causing a gout attack. This comes on suddenly and can be painful. Doctors can confirm it’s gout by checking for uric acid crystals in your joint fluid.
Intercritical Gout: After an attack, you might not have any symptoms for a while. But uric acid can still build up during this time, so it’s important to keep an eye on it and stick to any treatment your doctor recommends.
Chronic Tophaceous Gout: If uric acid levels stay high for a long time, it can lead to chronic tophaceous gout. This is when urate crystals form lumps called tophi in different parts of your body, like your joints or under your skin. It can cause joint damage and other problems if it’s not managed properly.

What Causes Gout?

Increased Uric Acid Levels: This condition referred to as hyperuricemia is a main trigger for gout as it can lead to the formation of urate crystals in the joints.

Impaired Excretion Pathways: This condition is a result of factors such as kidney disease or certain medications that interfere with uric acid excretion. As a result, the accumulated uric acid crystallizes in the joints, triggering inflammation and pain.

Genetic Factors: Genetic factors are crucial in gout, specifically those affecting how the body handles uric acid. Studies have shown that 65% of gout cases are inherited or run in the family. Recognizing genetic influences like identifying family medical history along with lifestyle modification will help individuals at higher risk.

Diet and Lifestyle Factors: High purine foods (e.g. crustaceans, red and organ meats, oily fishes) and alcohol or sugary beverages are the most common causes of the spike in uric acid levels. What you do daily and what you give your body is essential in treating gout as it could help lower uric acid levels and reduce strain on the joints, therefore preventing gout flare-ups.

What Are the Symptoms of Gout?

Joint Pain: This is described as a sudden throbbing or burning pain in the joints such as your big toe, knees, elbows, and wrists.
Joint Swelling: The affected joint usually becomes swollen, tender, and warm to the touch. Swelling occurs due to the accumulation of urate crystals, which trigger an inflammatory response in the joint tissues.
Redness: Gout attacks are often accompanied by redness in the affected joint. This redness is a visible sign of inflammation caused by the accumulation of urate crystals.
Limited Range of Motion: Pain and swelling associated with gout can restrict the joint’s range of motion, making movement difficult and causing stiffness.
Fever: This may occur in some individuals as part of the body’s response to a joint’s inflammation.
Joint Stiffness: Gout attacks frequently lead to joint stiffness, particularly following periods of inactivity or during the early morning. This stiffness may improve with movement but can persist throughout the day.

How Is Gout Diagnosed?

Diagnosing gout involves a thorough assessment of symptoms, medical history, and laboratory findings. Healthcare providers begin by evaluating the distinct traits of joint pain, considering its sudden onset, severity, and associated symptoms like swelling and redness.

They also explore potential risk factors such as family history, dietary patterns, and existing medical conditions such as hypertension or kidney disease. This approach ensures accurate identification of gout, enabling healthcare providers to implement appropriate treatment and preventive measures effectively.

Genetics Predisposition of Gout

Our understanding of gout genetics has been completely transformed by Genome-Wide Association Studies (GWAS) and Mendelian Randomization (MR) investigations. These studies have greatly improved our grasp of the genetic factors behind gout. By involving diverse populations in studies and combining research findings, we can advance our understanding of how genetics influence gout and its connections to other health factors like hypertension as well.

A study, involving 88,347 participants, among whom 3.68% had gout and 13.52% had hypertension(with men representing 31.9% and a mean age of 51.1 years) used a new method called Mendelian randomization (MR) to identify the relationship between gout and hypertension. The result suggests that having gout might increase the chances of developing hypertension, while hypertension does not seem to have a causal effect on gout.

In addition, recent studies using Mendelian randomization have not only established the relationship between high uric acid levels and gout but have also broadened our understanding of the genetic factors involved. Our recent findings have revealed numerous other genes implicated in various stages of gout development. Among these, SLC2A9 (GLUT9) is involved in moving substances across cell membranes, playing a vital role in regulating uric acid levels in the body. Variation in the SLC2A9 gene may disrupt its function, potentially disrupting uric acid metabolism and contributing to the development of gout. Additionally, numerous genes such as SLC22A11 and GCKR also contribute to regulating uric acid levels, expanding our understanding of the genetic factors behind gout.

Research in the UK Biobank has identified several genetic markers as well that are linked to uric acid levels, including GCKR, which regulates glucose metabolism in the liver. The GCKR gene has been associated with changes in uric acid concentrations, potentially affecting gout susceptibility through metabolic pathways. Another key gene, PDZK1, plays a crucial role in urate excretion through filtration by the kidneys until release via urination. Variations in PDZK1 can disrupt these interactions, leading to disturbances in uric acid handling and increasing the risk of gout.

A 2020 study has analyzed 190 DNA samples from pregnant Filipino women in Hawaii. It found that more of them carry a gene variant that is linked to a higher susceptibility risk of gout compared to Caucasians, Han Chinese, and African Americans. A specific variation rs2231142 G>T in ABCG2 was observed to be associated with a higher risk of hyperuricemia and gout. When ABCG2 doesn’t work properly due to genetic changes, it slows down the removal of uric acid. This can lead to higher uric acid levels in the blood, increasing the likelihood of developing gout. Even though none of the women had gout, the results suggest that Filipinos may have a higher genetic tendency for gout and high uric acid levels. This may be the reason why they seem to produce less urine acid than Caucasians, showing how genes, ethnicity, and diet all play a role in developing gout.

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Non-Genetic Risk Factors for Gout

Age: The likelihood of developing gout increases with advancing age, with peak incidence typically occurring in older adults.
Diet: Consumption of high-purine foods such as red meat, seafood, and sugary beverages, as well as alcohol, can elevate uric acid levels, increasing the risk of gout.
Obesity: Excessive body weight is associated with higher uric acid levels, predisposing individuals to gout.
Medications: Certain medications, particularly diuretics used to treat hypertension and heart failure, can interfere with uric acid excretion, raising the risk of gout.
Medical Conditions: Conditions such as hypertension, diabetes, and kidney disease are linked to metabolic abnormalities that contribute to elevated uric acid levels, increasing susceptibility to gout.

Can Gout Be Treated?

Although gout cannot be cured, it can be effectively managed with various approaches that help reduce symptoms, control inflammation, and prevent future flare-ups. Here are some common treatment options:

Lifestyle Modifications

Hydration: Making sure that you are drinking plenty of water helps prevent uric acid crystallization in the joints, this reduces the frequency and severity of gout attacks.
Dietary Changes: Dietary changes are important because they address one of the primary causes of gout, which is the high uric acid level. This will help to prevent flare-ups and manage symptoms more effectively. Reducing red meat and opting for lean meats instead can be beneficial. Limiting seafood, sugary foods, and alcohol also helps lower uric acid levels, decreasing the risk of gout attacks. Consuming more fruits, vegetables, low-fat dairy, and lentils for protein can effectively manage gout by further lowering uric acid levels.
Weight Management: By maintaining a healthy weight through exercise and diet, individuals can help lower their uric acid levels and lessen the strain on their joints.
Regular Monitoring: Having regular check-ups for uric levels and kidney function helps doctors see if treatments are working and catch any problems early. This way, they can adjust treatments as needed and prevent any serious issues related to gout.

Medications

NSAIDs: Common examples like ibuprofen and naproxen are used to help pain and reduce inflammation during gout attacks, providing relief from pain, swelling, and redness in the affected joints.
Colchicine: This is a medication particularly helpful when taken at the start of a gout attack. It works by calming down inflammation in the body and stopping the build-up of urate crystals in the joints, which are the main cause of gout symptoms.
Corticosteroids: These are other treatment options for gout that reduce inflammation throughout the body and help relieve pain and swelling associated with gout attacks. Corticosteroids can be taken as pills or injected directly into the affected joint.
Xanthine Oxidase Inhibitors: Allopurinol and febuxostat, are medications that work by reducing the production of uric acid in the body. This helps lower the levels of uric acid in the bloodstream, which is crucial for preventing gout attacks. These medications are commonly used for long-term management of gout to keep uric acid levels under control and reduce the frequency of flare-ups.

Joint Care

Rest and Elevation: Elevating the joint above heart level helps promote circulation and drainage of excess fluid, reducing swelling and further relieving pain. Resting the joint reduces movement and stress on the inflamed area, which can help reduce pain and swelling during gout attacks.
Cold Compresses: The numbing effect of the cold can offer temporary relief from symptoms. This is a simple and effective way to help decrease inflammation and reduce swelling.

Surgical Options

Joint Aspiration: This is a minimally invasive procedure performed to drain extra fluid from a swollen joint. This treatment also known as Arthrocentesis is commonly performed in cases of severe gout attacks with significant inflammation and fluid buildup. This helps ease discomfort, improve joint movement, and can be followed by other treatments to address the underlying cause of joint inflammation.
Surgical Removal of Tophi: In cases where tophi, which are accumulations of urate crystals, grow to be large, painful, or lead to joint deformities, surgical removal might be required. This procedure aims to relieve symptoms and prevent further complications associated with gout.

References

*Understanding your genetics can offer valuable insights into your well-being, but it is not deterministic. Your traits can be influenced by the complex interplay involving nature, lifestyle, family history, and others.

Our reports and suggestions do not diagnose or treat any health conditions or provide any medical advice. Consult with a healthcare professional before making any major lifestyle changes or if you have any other concerns about your results.