Scientists at the University of California San Diego have made a major discovery about gout, a painful kind of arthritis.
This new research may help explain why gout causes such strong joint pain and damage, and it could lead to better treatments in the future.
Gout happens when too much of a substance called urate builds up in the body. Urate is created when the body breaks down certain foods, especially ones high in purines like red meat and alcohol.
When there is too much urate, it can form sharp crystals in and around the joints—often starting in the feet or toes. These crystals cause sudden, intense pain, swelling, and redness. If gout is not treated, it can damage the joints and make movement difficult.
Doctors used to think that having high urate levels in the blood—also called hyperuricemia—was the main cause of gout. But many people with high urate levels never get gout.
In fact, it’s more common to have high urate levels without symptoms than to actually have the disease. Also, gout patients often have more urate in their joint fluid than in their blood. This made scientists wonder what else might be going on inside the joints.
In their new study, researchers looked at a rare case. A patient had urate crystals in the joints and joint damage but normal urate levels in the blood.
The scientists discovered that this patient had very low levels of a protein called lubricin. Lubricin is found in joint fluid and helps the joints move smoothly. It also plays a role in calming the immune system inside the joints.
Further lab tests showed that lubricin helps prevent urate crystals from forming by keeping urate levels and an enzyme called xanthine oxidase in balance. This enzyme creates urate in the body. Lubricin also seems to block the harmful effects of urate crystals, which can trigger swelling and joint damage.
When researchers tested joint fluid from other gout patients, they found that many of them also had low levels of lubricin. This suggests that high urate levels alone might not cause gout. Instead, a person may also need to have low lubricin or certain genes that affect lubricin to develop the disease.
This new understanding could lead to a new kind of gout treatment. Instead of just lowering urate levels, future treatments might try to boost or protect lubricin levels in the joints. This could help reduce pain, prevent joint damage, and improve the lives of people with gout.
The study was led by Dr. Robert Terkeltaub and published in the journal Arthritis & Rheumatology. It gives new hope to people living with gout and shows how modern science is uncovering better ways to understand and treat the disease.
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