Hypouricemia

Gout is a chronic inflammatory disease that affects nearly 4% of the population in the United States (Tophi and frequent gout flares). In fact, it is the most common form of crystal-induced arthropathy, and the most common inflammatory arthopathy in men older than 40 years (Bolognia, First Consult). Gout is a deposition disease of metabolic origin caused by supersaturation of monosodium urate, or hyperuricemia. Needle-like crystals are deposited into joints, connective tissue, and the kidneys. This deposition may lead to various clinical sequelae such as arthritis, tophi, and acute kidney injury (Bolognia). Gout can transition through many phases including asymptomatic, acute, and chronic disease (3). Environmental or genetic causes contribute to development of hyperuricemia (3). Men are more affected by gout than women, related to an estrogen-induced increase in urate clearance by the kidney (Rheumatology book). Primary forms of gout may be caused by inborn errors of purine metabolism or decreased excretion of uric acid by the kidneys. Secondary forms of gout are related to excessive cell turnover or secondary renal impairment (Tophi as first manifestion of gout). Increased turnover may be related to diets rich in purines including proteins, fats, and sugary foods like soft drinks (Tophaceous gout in finger pads). Under-excretion of uric acid by the kidneys accounts for up to 90% of gout cases (Tophi as first mani). Heavy alcohol intake and medications including diuretics,…