This is my original explanation of how uric acid causes gout pain, from some time before 2008. It exposes the commonly believed myth that gout pain comes from sharp uric acid crystals embedded in our joints. In truth, gout pain comes from our inflammatory reaction to these crystals, which are too small to cause physical pain. This simple misunderstanding causes all kinds of problems during diagnosis and treatment.
GoutPal.com has grown considerably since I first published this explanation on the causes of gout pain, yet this simple process continues to support everything that I do here. The U-D-R-P process has now spawned an entire section (Understanding Uric Acid) to explain how uric acid and gout interact with our immune system to produce gout.
My Symptoms, Treatment, Diet Sections offer practical help and advice for coping with gout, but understanding uric acid gives you a much better chance of managing gout completely. If you do not have time to read all the Understanding Uric Acid Section, at least take time to read and understand the principles upon which it is based…
Uric Acid Causes Gout Pain
Everything you do as a gout sufferer affects how uric acid causes pain.
Each part of the U-D-R-P process is affected in some way by food, exercise, age, gender, medication or environment factors. The details of how and why different factors affect different parts of U-D-R-P are scattered throughout the website. Each of those pages features a diagram showing which part of U-D-R-P it deals with. This page describes the overview of U-D-R-P.
“And the point of this?” you may be asking. Read on…
Clouds of Gout
Gout is a very complicated condition, and there are a lot of aspects that are not fully understood. Even the parts that are understood are often presented in a confusing way, or misrepresented. Don’t get me wrong. Many people are happy with the advice and treatment they are receiving. If you are such a person, you need not worry too much about understanding U-D-R-P and how uric acid causes gout pain. But if, like me, you want to improve your quality of life without the misery of an overly restrictive regime, then you need to understand U-D-R-P.
- Uric Acid
Uric acid is produced as a by-product of metabolism. In humans, there are no enzymes that break down uric acid further, so it must be excreted. Approximately two-thirds is excreted through the kidneys in urine. Approximately one third is excreted through the bowel. Small quantities are also excreted in sweat and seminal fluid. The rate of excretion depends on several factors.
The amount of uric acid produced by the human body is dependent on several factors, including body mass, diet, and exercise. Age and gender should also be considered, though it is possible that these are really hormonal and/or lifestyle factors. Note that food is a factor in the amount of uric acid that the body produces. Food does not contain uric acid, but it can affect the amount of uric acid produced by as much as 15%.
The amount of uric acid in the body is a combination of the above, i.e. how much is produced less how much is excreted. Excess uric acid is not gout – it is Hyperuricemia. Symptoms of gout are likely to appear once the uric acid is deposited as crystals. There is no specific level when uric acid causes deposits.
Uric acid is not considered harmful in its own right, but it is the root of gout pain. To manage the U-D-R-P process you need to understand how the body creates and excretes uric acid.
- Uric Acid <> Deposits
When the amount of uric acid dissolved in the blood rises above a certain level, it forms crystals that are deposited in the body. Conversely, when the uric acid level falls below a certain level, any existing crystals will start to dissolve. The certain level referred to above is known as the saturation point. The saturation point is different for everyone, and it changes according to certain factors, including temperature and blood pH level. Other factors, such as injury, can also trigger a change in body chemistry that causes uric acid to crystallize.
To manage the U-D-R-P process you need to understand that uric acid causes deposits and why deposits re-dissolve.
These deposits are usually in the joints which cause the swelling typically recognized as gout. Uric acid can also be deposited as tophi (the plural of tophus), a condition known as tophaceous gout. In the most painful cases deposits may form as kidney stones.
To manage the U-D-R-P process you need to understand that uric acid causes deposits that may lead to pain immediately and in future.
- Deposits <> Reaction
Crystals deposited as a result of high uric acid levels, do not directly cause pain. The crystals cause the immune system to react in the same way as it does to a viral or bacterial infection. When uric acid levels in the blood fall, crystals dissolve. This also causes an immune system reaction – more pain even when you are trying to fix your gout!
To manage the U-D-R-P process you need to understand how uric acid deposits cause reactions when crystals form and when they dissolve.
At the heart of most gout problems is the reaction of the body to deposits of crystals. Wherever the crystals form, the immune system attacks the crystals as they would a virus or other infection. Once the crystals are encased then the reaction stops, removing the cause of painful swelling. This is not the end, however. The reaction, when applied to biological invaders, leads to the virus etc being killed thus removing the infection. With gout, the crystals are masked with a cell coating. When the crystals start dissolving, the coating is shed and the crystals are attacked by the immune system again.
- Reaction <> Pain
The immune system reaction causes inflammation leading to pain. This is why anti-inflammatories are particularly effective against gout pain. Swiss scientists have recently discovered the specific cause of pain, giving hope that new pain blocking medicines will be developed in future.
Finally, we see how uric acid causes gout pain. Yet pain is still very misunderstood. Everybody tolerates different levels of pain, and different treatments affect people in different ways. There is a growing range of medical and alternative remedies for pain relief which I am constantly researching and adding to the website.
The secret to managing gout is in two parts:
- Find a form of pain relief that suits you when you have an attack.
- Manage how uric acid causes problems in the long term by looking at all the factors affecting the U-D-R-P process.
Using U-D-R-P to see how uric acid causes gout pain makes it easier to look at all factors. You can look at all aspects of your lifestyle and, by checking the relevant GoutPal pages, gradually introduce changes that reduce how uric acid causes deposits and reactions that lead to pain.
I have found it almost impossible to distinguish between pain caused by uric acid crystals forming, and pain caused by uric acid deposits dissolving. This makes it hard to be certain which lifestyle factors are improving gout, and which are making it worse. This becomes easier when you understand the U-D-R-P process. You just need to be careful, when changing your lifestyle that diet, exercise, medication etc all work together to affect how uric acid causes gout pain. Only change one factor at once, and do so gradually. Drastic change is almost certain to trigger gout pain because a dramatic change in concentrations of uric acid causes deposits to change. These changes to deposits cause reactions then pain.
I have found that by gentle lifestyle and dietary changes I can gradually reduce the frequency and intensity of attacks. I realize that the only way to be free from gout is to reduce uric acid levels low enough and often enough to dissolve all deposits. You need to realize this and understand U-D-R-P before you can manage gout. It doesn’t matter which remedies and treatments you choose. Medications or alternatives can achieve a pain-free life and you must choose whichever suits you best.