Why painful gout hits harder in the South – and what can be done

Two UMMC rheumatologists are dispelling myths about gout, explaining prevention and treatment options, and revealing how this common, painful inflammatory arthritic condition is affecting adults – particularly in Mississippi and other Southern states. 

Dr. Rachana Marathi and Dr. Hanan Ibrahim, both assistant professors in the Division of Rheumatology at the University of Mississippi Medical Center, say gout begins with a buildup of uric acid in the bloodstream – a condition known as hyperuricemia. 

“Uric acid is a waste product formed from the breakdown of purines,” Marathi explained. “Unlike some other species, humans cannot effectively eliminate uric acid from their bodies.” As a result, when levels rise too high, crystals form because the body cannot dissolve excess uric acid. 

Ibrahim said, “During a gout attack, needle-shaped crystals of monosodium urate form in and around joints. When immune cells encounter these crystals, they trigger a cascade of inflammatory signals.” The result is sudden, intense pain accompanied by swelling, warmth and redness. 

Marathi added, “Gout can affect nearly any joint in the body, but it particularly favors the great toe. Cooler temperatures prevent the dissolution of uric acid crystals, causing them to crystallize in the cooler areas of the body.” 

Furthermore, Ibrahim noted, “It’s the coolest part of the body and experiences repetitive trauma from walking,” making the toe especially vulnerable. 

Both experts say many people think of gout as an occasional inconvenience, but they warn of serious health risks. 

If left untreated, the condition can progress to tophaceous gout, where clusters of uric acid crystals form in the joints of surrounding soft tissues, Marathi warned. “It can also cause kidney damage due to the formation of uric acid kidney stones, or gouty nephropathy.” 

Understanding who is most at risk is key to prevention and early treatment. 

“Serum uric acid levels tend to increase with age and are generally higher in men than in women,” said Marathi, adding that genetics play a major role. “Several genes regulate uric acid, and alterations in these genes can lead to hyperuricemia.” 

Ibrahim points to a broader set of modern risk factors: “Obesity, hypertension, chronic kidney disease, metabolic syndrome, diabetes and medications.” Her list also includes lifestyle factors such as diuretic use, alcohol consumption, and diets high in red meat, seafood and high-fructose corn syrup. 

Moreover, certain populations face an even higher burden. 

“African American men have a higher incidence, likely because of genetics and a higher prevalence of hyperuricemia and hypertension,” Marathi explained. She also noted that Pacific Islanders often develop gout earlier, sometimes before age 30, due to a combination of genetic and metabolic factors. 

However, Ibrahim noted that disparities go beyond biology. “Differences in health care access and social determinants also play a role,” she said. 

In Mississippi and throughout the South, those risks are amplified. 

“Obesity, metabolic syndrome and diabetes are more common in the South,” Marathi said. “Socioeconomic disparities, poor health literacy, limited access to medical care and poor dietary habits increase the incidence of gout.” 

Despite these challenges, gout is one of the most treatable forms of arthritis. 

Marathi said first-line treatments include anti-inflammatory medications such as nonsteroidal anti-inflammatory drugs, colchicine and corticosteroids. 

Ibrahim advises patients to keep medication on hand to start treatment immediately, suggesting a “pill-in-pocket” approach. 

For long-term control, both doctors stress the importance of lowering uric acid levels. 

“Since gout is a genetically predisposed condition, it requires long-term treatment with uric acid-lowering therapies,” said Marathi, noting highly effective medications such as allopurinol and febuxostat. 

For all its prevalence, gout remains largely absent from everyday conversation. 

Part of the reason, experts say, is stigma. Gout has long been associated with overindulgence – rich foods and alcohol – leading many to see it as self-inflicted. That perception discourages open discussion, even though genetics and chronic conditions play a major role. 

And in places like the South, it is often overshadowed by related conditions like diabetes and heart disease – despite being closely connected. 

Marathi and Ibrahim say bringing gout more prominently into the conversation may be the first step toward better health. 

To schedule an appointment with arthritis and rheumatology specialists at UMMC, call 601-984-5540 or visit here.

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