Gout, a complex and painful form of arthritis, is characterized by sudden, severe attacks of pain, redness and tenderness in joints, often the joint at the base of the big toe. Men are more likely to get gout, but women become increasingly susceptible to gout after menopause. People with kidney disease are also more susceptible. Over 8 million Americans have gout.
Gout occurs when urate crystals accumulate in your joint, causing the inflammation, swelling and intense pain. Urate crystals can form when you have high levels of uric acid in your body, including in the bloodstream (called “hyperuricemia”). Over time, increased uric acid levels in the blood may lead to deposits of urate crystals in and around the joints. These crystals can attract and activate white blood cells, leading to severe, painful gout attacks and chronic arthritis. Uric acid also can deposit in the urinary tract, causing kidney stones.
Gout has been called the “Disease of Kings” because it was thought that it was caused by overindulgence in rich food and drink only affordable by the very wealthiest citizens. High levels of uric acid can be the result of a diet high in red meat and shellfish, alcohol, sugary drinks and food high in fructose, but there are other risk factors, too, including obesity, high blood pressure, family history and as a side effect of several different medications. A rheumatologist can guide patients on how to best modify their diet and will treat gout based on each patient’s specific symptoms.
Some other kinds of arthritis can mimic gout, so proper diagnosis is key. Health care providers suspect gout when a patient has joint swelling and intense pain in one or two joints at first, followed by pain‐free times between attacks. Early gout attacks often start at night.
Diagnosis depends on finding the distinguishing crystals. The physician may use a needle to extract fluid from an affected joint and will study that fluid under a microscope to find whether urate crystals are present. The crystals also can be detected using high resolution ultrasound. Crystals also can be found in deposits (called tophi) that can appear under the skin.
*Reference: American College of Rheumatology, www.rheumatology.org
Mara McAdams DeMarco, PhD
Johns Hopkins University
Gout is the most common form of inflammatory arthritis and disproportionately affects adults over the age of 65; an estimated 4.7 million older adults have been diagnosed with gout in the US. There is increasing awareness that the risk factors, clinical presentation, and progression of gout differs for older adults.
To address the growing public health burden and distinct clinical aspects of gout in older adults, Dr. McAdams DeMarco’s research will estimate the number of older adults who develop gout, identify risk factors for gout in older adults, and determine the impact of gout on physical function in older adults. The findings from this research will lead to a better understanding of the burden, risk factors, and consequences of gout in older adults and will directly benefit patients and providers by characterizing this inflammatory arthritis in an understudied population.
Dr. DeMarco’s study was co-funded with ANRF collaborative partner, American Federation for Aging Research.
Laurent Reber, PhD, 2nd-year grant recipient
Gout and pseudogout are chronic inflammatory diseases caused by the buildup of urate crystals in joints tissues. Defining which cell types in the affected joints initiate and/or perpetuate the inflammatory response induced by such crystals is an essential step towards finding more effective treatments.
Mast cells are potent pro-inflammatory immune cells which are abundant in the joints but their role in gout and pseudogout remains unknown. In this project, Dr. Reber will define mechanisms by which mast cells contribute to joint disease in mouse models of gout and pseudogout and assess whether and to what extent targeted inhibition of mast cell functions can reduce inflammation and progress of the disease.
“Dr. Reber’s findings represent a major advance in not only understanding gout, but also in understanding what mast cells do in the joint,” according to world-renowned gout expert and ANRF Scientific Advisory Board member, Robert Terkeltaub, MD, of the University of California, San Diego.