Gout

Gout is the most common inflammatory arthritis in men over the age of 40, although it can happen in younger age groups. Women are typically protected from gout until after menopause.

Common triggers of gout are: alcohol, over consumption of red meat or seafood, dehydration, extreme dieting, surgery or joint injuries.

Gout may occur independently or as a complication of other diseases, for example kidney failure or leukaemia.

It is also associated with:

• ​Diabe​tes mellitus
• High blood pressure
• High cholesterol
• Certain medication (may trigger or aggravate gout)
  

A history of sudden onset joint pain with redness and swelling, separated by periods of normal joint / no pain is strongly suggestive of gout.

Presence of tophi on physical examination or uric acid crystals in fluid removed from an affected joint can also indicate gout.

 

The first attack of gout may settle on its own within a week. Patient will remain symptom-free until the next attack.

The aims of gout treatment are to treat acute attacks and lower the uric acid levels in the body to prevent further attacks in the long term.

During a gout attack, you should:

1. Rest your joints
2. Take medication to reduce inflammation (Please seek doctor’s advice.)

If gout is not controlled, attacks may become more frequent and last longer. Over time, more and more joints may be affected and they may become deformed. This may lead to chronic pain and stiffness, as well as loss of function.

In some patients, uric acid crystals may get deposited underneath the skin and in tissues, and form lumps. These are tophi which may be found around the joints or along the outer edge of the ears. Tophi may be infected or rupture. Uric acids may also form stones in the kidney. This may cause pain and kidney damage.

Medication used for acute gout attacks:

1. Non-steroidal anti-inflammatory drugs (NSAIDs) like diclofenac or arcoxia are often prescribed to reduce the pain and swelling.
2. Colchicine is also very effective in relieving acute pain from gout.
3. Corticosteroids for:
   - Patient who are unable to take NSAIDs or colchicine may need a short course of steroids (e.g. Prednisolone)
   - Steroids may be injected into the joint to provide relief

In the long term, your doctor will consider giving medication to lower your blood uric acid levels and prevent gout attack. Common drugs used are allopurinol, febuxostat and probenecid. Over time, these medications reduce sizes of tophi and prevent formation of kidney stones. These drugs will need to be taken long term and continued during a gout attack. Stopping them may cause recurrence of gout attacks.

Surgery does not treat gout. However, it may be performed when tophi are infected or joint movements are affected.

Yes! Diet plays an important role in gout management and its modification is important in preventing gout attacks.

The general principles are:

1. Avoid food and drinks that are and high in fructose and limit consumption of naturally sweetened fruit juices
2. Avoid food that are rich in purines such as red meat, anchovies, sardines, mackerel, organ meat (brain, kidney, liver, heart) and shell-fish (e.g. scallops, mussels)
3. Avoid alcohol (beer / spirits) as excessive intake results in accumulation of lactic acid in the blood which then prevents the clearance of uric acid by the kidney
4. Stay well hydrated

Studies have shown that vegetables high in purines (e.g. asparagus, spinach) do not increase the risk of gout.

It is also important to lose weight if you are overweight, as obesity is often associated with gout. Weight reduction should be gradual. Fasting or drastic dieting may precipitate gout attacks.