Primary and Secondary Gout

Gout results when uric acid crystals are deposited in the tissues and fluid surrounding the joints causing swelling and pain. The deposition of uric acid crystals is due to its excessive amounts in the blood and tissues which is either caused by its overproduction or inefficient removal by the kidneys. When gout occurs alone and not as a result or complication of other diseases, it is called primary gout. On the other hand, when it is a direct result or complication of other diseases or complication from treatment of other diseases it is called secondary gout.

Primary Gout

Primary gout when caused by excessive production of uric acid is due to specific enzyme defects. This is most likely from overproduction of the enzyme xanthine oxidase which is responsible for breaking down purine into uric acid. Enzyme defect could also mean an anomalous purine synthesis resulting to overproduction of uric acid. Primary gout may also be caused by decreased uric acid removal by the kidneys which could either be idiopathic in nature. Idiopathic means arising from an unknown cause which is usually the most cited cause of primary gout. It could also be caused by familial juvenile gouty nephropathy which is rare, inherited early onset (occurring in teenage years) gout.

Secondary Gout

Secondary gout maybe from over production of uric acid caused by such medical condition as myelo or lymphoproliferative disorders (such as leukaemia and lymphoma) occurring in patients with compromised immune systems producing excessive lymphocytes. It can also be complication of chronic haemolytic anaemia and severe proliferative psoriasis. It can also result from Gaucher’s disease, a genetic disease where fats accumulate in the cells and certain organs. Secondary gout may also be due to decreased elimination by the kidneys resulting from such conditions as chronic renal mass, kidney injury, hypertension, sickle cell anaemia, beryllium or lead poisoning and diuretic drugs or low-dose aspirin.

Primary gout usually occurs in men and women aged 30 to 60 years old and secondary gout usually for much older people or those suffering severely from metabolic diseases. In terms of medication, most drugs for gout are developed for primary gout. There are certain medications however developed for secondary gout arising from tumor lysis syndrome (TLS) which is high uric acid from such diseases as leukaemia and lymphoma.

Distinguishing between primary and secondary gout is important especially in terms of treatment of secondary gout. The objective of such treatment is always to treat gout without worsening the underlying condition causing it.