4-6 These studies have discovered eight DNA sequence variations associated with varying degrees of increased serum uric acid the SLC2A9, SLC22A11, and SLC22A12 genes, which correspond with the Glut-9, OAT1, and URAT1 transporters, respectively, have been highly associated with hyperuricemia. Genome-wide association studies have identified several variants that increase a patient's relative risk of developing hyperuricemia and gout. In the past, gout was thought to be a monogenic trait however, recent studies suggest a polygenic mode of inheritance. 3 Although gout may affect all ethnicities equally, higher prevalence is well documented in some Asian, Maori, and Pacific Islander populations. 2 The sex discrepancy equalizes after women undergo menopause, suggesting that estrogen (specifically estradiol) plays a role in uric acid regulation. 2 More men than women in this age group are affected. 2 Recent epidemiologic data suggest that the risk of developing gout is age-related, with the typical age range between 40 and 69 years at diagnosis. 2 Hyperuricemia, defined as a serum uric acid level greater than 6 mg/dL, is reported in 21% of the US population, correlating with a substantial rise in obesity and hypertension. EPIDEMIOLOGYĪbout 8.3 million people in the United States (about 3.9% of the population) have gout, compared with about 2.7% of the population in the early 1990s. This article reviews the pathophysiology and general management of gout, advances in genetics, usefulness of diagnostic imaging, and new therapies. Advances and developments in genetics, imaging, and medications have been emerging rapidly. Understanding the disease process is critical to effective management. 1 However, the Western diet has developed into one that is purine-rich, regardless of income levels, contributing to the rise in gout in the United States. Historically, the imbalance has been linked to excesses that could only be afforded by the wealthy. 1 Advances in medicine eventually identified the actual excess “humor” in gout to be uric acid. 1 Hippocrates described it as an “unwalkable disease.” In keeping with Hippocratic medicine, medieval people associated gout with an imbalance of one of the four humors that maintained a person's health. Podagra was first documented in ancient Egypt. Gout is an ancient disease that is on the rise in the United States.
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