What is Gout?

Gout is a common disease of the joints. Patients may experience sudden, severe attacks of pain, redness and tenderness in the joints, especially at the base of the big toe. Patients may wake up in the middle of the night with a burning sensation on the big toe.

The affected joint is so painful that the patient may have difficulty turning over in bed. The most commonly affected joints are the big toe, foot, ankle, heel, instep and knee. Gout rarely affects the joints of the upper limbs such as the fingers or wrists.

Gout is caused by accumulation of uric acid in the joints. When the kidneys cannot excrete excess uric acid in the urine, it is deposited in the joints, where it forms crystals (tophi). These crystals cause swelling and pain in joints. Other causes of gout include:

  • A diet excessive in proteins, fat, and alcohol
  • Certain medications
  • Gender — men are more likely to get gout, but women have a higher risk after menopause
  • Hereditary — gout often runs in families because of a genetic connection
  • Other diseases such as diabetes, hypertension, leukaemia and kidney disorders

The first sign of a gout attack is a sudden warm throbbing of the affected joint. This pain can quickly become excruciating, accompanied with swelling and redness of the joint. Other symptoms include:

  • Difficulty and pain in walking during an acute attack
  • Extremely large uric acid crystals or tophi in the joints or other tissues
  • Chronic pain with reduced movement in the involved joint
  • Tender, sensitive, and sore skin around the joint that is extremely painful to touch

The initial episode usually subsides completely within a week.

There is currently no cure for gout, but the symptoms can be controlled by a combination of medication and a special diet:

  • Take up a  “low-purine” diet to reduce the level of uric acid in the blood (Purine is broken down in the body and changed to uric acid):
    • Abstain from foodstuff rich in purine such as alcohol, liver, kidney, salmon, sardine, gravies and sauces made with meat, goose, duck, tuna, codfish, herring, crab, lobster, shrimp, oysters, asparagus, cauliflower, mushroom, spinach.
    • Limit the daily intake of protein-rich food such as red meat
  • Prescribe colchicine (an anti-gout medicine) for effective pain relief and prevention for acute attacks
  • Prescribe non-steroidal anti-inflammatory drugs (NSAID) to reduce the pain, swelling, and stiffness
  • Inject steroids directly into the joint in case of extremely acute pain attack
  • Surgery is rarely used to treat gout, but it may occasionally be necessary to remove infected uric acid crystals, or those that interfere with joint movement

Uric acid crystals tend to recur unless the high uric acid level in the blood is reduced.

If gout is left untreated, the affected joints may become damaged, causing deformity and restricted mobility. Deposits of uric acid crystals may form under the skin in nodules. Gout episodes may become more frequent if the high uric acid level is not reduced. Uric acid crystals may collect in the urinary tract, causing kidney stones. Patients with chronic gout may be subject to reduced kidney function or kidney failure and high blood pressure.

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