Gout disease is a common form of inflammatory arthritis characterized by recurrent attacks of painful joint pain. Category: bone, joint and muscles disorder, metabolic disorders.
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Cushing syndrome is a group of conditions caused by high levels of circulating cortisol or related corticosteroids.
A gout attack occurs suddenly, often at night. The affected joint is swollen, red and warm to touch. The initial attack usually involves only one joint, most often in the big toe, and lasts a few days. Subsequent flares may involve multiple joints and can last for weeks, with shorter intervals of remission in between.
Gout is caused by deposits of urate crystals in the joints, which may happen when blood levels of uric acid are too high. Uric acid is a waste product from the breakdown of purines, a major component of DNA and RNA. Because body’s cells are constantly renewed, uric acid is constantly produced and removed in urine. High serum urate level may result from decreased urate excretion, increased urate production, and/or overconsumption of purines.
The most common cause is the kidney’s decreased ability to excrete uric acid, which can be hereditary, or a result of kidney diseases, medications such as diuretics, alcohol use, or lead poisoning. Increased production of urate may occur in conditions with abnormally high cellular turnover or cell death, or in obesity, as urate production increases with greater body surface area. Overconsumption of purine-rich foods can contribute to higher urate level, but is rarely the only cause.
High concentration of urate promotes its precipitation and formation of crystals in joints, causing inflammation and pain. Because uric acid crystals form more easily in cooler temperatures, gout more often affects joints of the extremities. Urate crystals may also deposit under the skin around the joints, forming hard lumps, called tophi, that are not usually painful but can limit joint motions and lead to deformities. Joint damage caused by gout also increases the risk of developing osteoarthritis. In the kidneys, urate deposits may form stones, blocking urine flow.
Gout is more common in men. It often starts in middle age in men, and after menopause in women. Other risk factors include diets, obesity, other health conditions, family history, and surgery or trauma.
Diagnosis requires detection of urate crystals in synovial joint fluid. Because not all people with high serum urate levels develop gout, a blood test alone is not sufficient for diagnosis.
Acute gout attacks are treated with anti-inflammatory drugs, such as NSAIDs, regular use of which may also help prevent or reduce frequency of attacks. Because tophi can be dissolved by lowering serum urate, medications that block urate production or increase urate excretion may be used for this purpose.
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Gout may be triggered by an increasing level of uric acid in our body. It guarantees an intense pain usually at the big toe joints and is more likely to flare at night (approximately 2.4 times more frequent than the daytime). This is because the concentration of uric acid increases while we’re sleeping. While asleep, through breathing and sweating, our body loses moisture. Less water content in the blood equals higher concentration of uric acid and may lead to hyperuricemia, the precursor to gout.

Holding our breath while sleeping is out of the option so the other factor that we can control to manage our uric acid level is through diet. Avoid eating a diet rich in red meat and seafood with high purine content. It’s also highly risky to consume alcohol and beverages sweetened with fruit sugar. Further treatment includes several types of drugs that can block the uric acid production such as Allopurinol and Febuxostat.

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REFERENCES:
Purines made in the body
https://www.sciencedirect.com/science/article/pii/S0167527315303429
Extra urate is flushed out through urine
https://www.uofmhealth.org/health-library/aa15402
Foods with high purine content
https://www.medicalnewstoday.com/articles/322590
Gout Diet
https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/gout-diet/art-20048524
General
https://www.cdc.gov/arthritis/basics/gout.html
https://www.niams.nih.gov/health-topics/gout
https://www.nhs.uk/conditions/gout/
https://my.clevelandclinic.org/health/diseases/4755-gout

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