Elevated blood uric acid and gout are common conditions in the United States. Data from the National Health and Nutrition Examination Survey 2007-2008 (NHANES) has indicated that gout affects almost 4 percent of the population.
That’s 8.3 million people. But more disturbing is the fact that gout incidence has more than doubled in the last couple of decades. There are many reasons for this including the rising incidence of other medical conditions that are risk factors for gout. These diseases include elevated blood lipids, diabetes, high blood pressure, and obesity. The sum total of these conditions is often referred to as the “metabolic syndrome.” The metabolic syndrome appears to be the end result of lifestyle choices that are commonplace in the United States.
The economic burden of gout is tremendous and is due to increased frequency of emergency room services, increased doctor visits, and the costs of medications. In addition, as has been described earlier, gout is associated with other common medical conditions that also carry a hefty price tag.
While most people perceive gout as being just a painful form of arthritis, it is more than that. Because of its association with the above medical conditions, it is now recognized as a substantial risk factor for death due to cardiovascular disease. What is more surprising is that this elevated risk is independent of these other factors including the presence of high blood pressure, diabetes, age, gender, and elevated blood lipid levels.
Another disturbing association is gout and kidney disease. Many people with gout have kidneys that don’t function at 100 per cent efficiency. Since uric acid is excreted through the kidneys, the eventual result is that there is less uric acid excretion and therefore gradual accumulation leading to elevated blood levels of uric acid. This sets up a vicious cycle since elevated blood levels of uric acid can make the kidney disease worse. Uric acid has been shown to causes inflammation of blood vessels which could contribute to the kidney damage as well as possibly to the cardiac issues described earlier.
Roughly, 60 per cent of people with gout have some degree of kidney dysfunction. The problem is that medications used to treat acute gout attacks such as non-steroidal anti-inflammatory drugs and colchicine may have an adverse effect on kidney function. Also, the traditional medicine employed for reducing serum uric acid, allopurinol, also must have dose adjustments made in the presence of kidney abnormalities.
It is clear that gouty arthritis is a public health issue that causes significant morbidity as well as mortality and must be addressed more aggressively.