The four phases of gout include elevated uric acid levels without symptoms, acute gouty arthritis, multiple attacks with intervals between attacks, and chronic tophaceous gout, in which nodular masses of uric acid crystals are deposited in different soft tissue areas of the body. Patients with asymptomatic hyperuricemia do not require treatment, but efforts should be made to lower their urate levels by encouraging them to make changes in diet or lifestyle.
Uric acid is a product of the chemical breakdown of the purine bases that compose the genetic material, DNA. As cells die and release DNA from their chromosomes, purines are converted into uric acid which is excreted in the urine and, to a lesser extent, the intestinal tract. The level of uric acid dissolved in the bloodstream is directly related to this delicate balance between uric acid production and excretion. The normal level is approximately 2-7mg/dl. Though an excess of uric acid is known to cause gout, recent studies show that, in proper concentrations in the blood, it has antioxidant properties and helps protect the cells and tissues from irritation and damage caused by singlet oxygens and hydroxyl free radicals. This protection may prevent tissue wear and aging, in addition to other free-radical diseases.
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