Gout

Gout was historically known as 'the disease of kings' or 'rich man's disease' as it is more common among the rich royal and noble men due to excessive indulgence of expensive spread of delicacies such as meat and wine. However, gout is no longer a disease of nobility as it can affect anyone from all walk of life.

Gout is a chronic form of inflammation to the joints caused by an excessive level of uric acid in the blood known as hyperuricemia.  The body makes uric acid when it breaks down purines, which are found in your body and from the foods you eat. When there is too much uric acid in the body, uric acid crystals (monosodium urate) can start to build up inside the joints. Hyperuricemia does not always cause gout, and hyperuricemia without gout symptoms does not need to be treated. There is no cure for gout, but you can effectively treat and manage it with medication as well as healthy diet and lifestyle changes.

Gout can affect any joint in the body but first and most common attack of gout involve big toe, known as 'Podagra'. Gout tend to initially affect the smaller joints and tendons such as the toes, feet, ankle, fingers, achilles tendon and earlobe. Over time if not managed, it will then start to attack bigger joints such as the knee, elbow, wrist and shoulder. Gout flare can start suddenly and usually last from several days to weeks. The flares are then followed by period of remission with no symptom. Repeated attack of gout can lead to gouty arthritis, a severe form of inflammation of the joint cause by gout. Chronic gout can lead to permanent joint deformities due to formation of 'tophi' when uric acid crystals form masses of white growth around the joints and tissues which can then affect joint mobility and become ulcerated and infected. This will often require surgical fixation and debridement. 

Symptom of gout include intense pain, swelling, redness, stiffness and the joint is warm to touch. You may also have difficulty to move the affected joint due to severe pain. Risk factors of gout and hyperuricaemia are genetic, being male and obese, having certain chronic illness such as high blood pressure, high cholesterol, diabetes and insulin resistance, heart problem and poor kidney function. You also at risk of more frequent attack if you drink alcohol or having a diet that is high in purines such as red meat, veal, venison, duck, animal internal organs, seafoods (such as anchovies, mussels, scallops and sardines, oyster, tuna, shrimps), nuts and sweetened beverages.

Gout can be diagnosed by your symptoms, physical examination of the affected joint, tests like X-ray and uric acid level. Occasionally fluid can be taken from the affected joint and analyse to confirm presence of crystal in the join.

Gout can be effectively treated and managed by medication like nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or voltaren, oral steroid and anti-inflammatory drug such as colchicine. Side-effects from Colchicine include diarrhoea, nausea, vomiting and stomach cramps. You also need to ensure adequate hydration to help the kidney excrete out the excess uric acid from the urine. To prevent future attack you need to start making healthy lifestyle change by reducing your weight, regular exercise, cutting down alcohol consumption and purine-rich foods. If you get recurrent attack, your doctor may prescribe you medications like Allopurinol and Feboxostat to reduce the level of uric acid in the blood. The use of urate-lowering medication can prevent development of tophi, kidney stones and chronic kidney disease leading to kidney failure. 

Gout is an independent risk factor for cardiovascular disease. It is important to practice healthy lifestyle if you are diagnosed with gout as it can not only reduce the number of gout attack but also prevent complication from excessive uric acid level and development of cardiovascular disease in the future.

If you suffer from gout, talk to our doctor today on ways to manage your gout better.