Gout Causes and Treatments
Gout is a type of inflammatory arthropathy (joint disease) that is increasingly common worldwide. In fact, it is the most common inflammatory arthritis globally. While most people think that gout is a disease that develops mainly in the elderly, trends have shown that the prevalence of gout within the younger population has been increasing in recent years.
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Gout in Singapore
Approximately 4.2 per cent of Singaporeans suffer from gout. Gout is becoming increasingly common and gout patients, similar to the global trend, have been getting younger. Gout also tends to be accompanied by associated chronic diseases that are extremely common in Singapore’s ageing population. These include diabetes, high cholesterol and hypertension.
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What is Gout?
Gout is a chronic disease that causes intermittent painful arthritis, commonly in the joints of your lower body, such as the knees, ankles and big toes. Gout symptoms can suddenly flare up or subside. A gout flare up can cause excruciating pain which will affect your daily activities. As a chronic disease, there is no cure for gout, but it can be effectively treated and managed with medication and self-management strategies.
Gout is the result of hyperuricemia, where there is an excess of uric acid in your bloodstream. Uric acid can form crystals in the joints and tissues, causing inflammation and pain. Uric acid is produced when purine is broken down. Purine is found in your body, food and drinks. A diet that contains foods high in purine can increase your risks of developing gout.
Gout Symptoms
Gout attack can happen anytime, but symptoms of gout tend to surface at night. These can include:
- Intense joint pain. Gout causes intense joint pain which usually affects the big toe, but can also affect the ankles, knees, elbows, wrists and fingers.
- Lingering discomfort. After the pain subsides, you may continue to experience discomfort near the affected joint.
- Inflammation of the joints and redness. The affected joints usually swell due to inflammation, with redness near the affected areas.
- Limited range of motion. As gout continues to worsen, the affected joints will experience a loss in their range of motion.
Gout that goes untreated can quickly lead to worsening pain and irreversible joint damage. If you experience gout symptoms, it is advised that you seek a doctor’s opinion on the matter.
Gout Risk Factors
Here are some of the risk factors that can increase your chances of developing gout:
- Diet. A diet that is rich in red meat and shellfish, with regular consumption of beverages that are sweetened using fructose can increase the amount of uric acid in your body. This is due to the high amount of purine that the body reacts to by producing uric acid. Alcohol consumption can also contribute to this, especially in the case of beer.
- Weight. People who are obese or overweight often produce more uric acid, which their kidneys are unable to eliminate.
- Medical conditions. Some diseases and conditions can heighten your risk of developing gout. These include chronic conditions such as high blood pressure, diabetes and hypertension. It is especially dangerous if these conditions are left undetected or untreated.
- Medications. Some types of medications can increase uric acid which increases your risk of developing gout. These include low-dose aspirin and medications commonly used to control high blood pressure such as thiazide diuretics, angiotensin-converting enzyme (ACE) inhibitors and beta blockers.
- Family history. If you have a family member who has had gout, your risk of developing the disease is higher.
- Age and Sex. Gout tends to develop more frequently in men and can happen between the ages of 30 to 50. Gout is more common among women after menopause.
While some of the risk factors such as age and family history cannot be changed, you can make changes to your diet and lifestyle in order to lower your risk of gout.
Complications of Gout
Gout can cause more than just pain. Chronic gout, if left untreated, can lead to several serious health consequences. This can include:
- Tophi. Tophi refers to clumps of urate crystals that harden beneath your skin. These crystals can form on most joints and cartilage. While tophi do not cause pain, they can cause irreversible damage to your joints, bones and cartilage if left untreated.
- Joint damage and deformity. Chronic gout can cause your joints to swell regularly. Constant inflammation and tophi can lead to permanent joint damage, which will require surgery to fix.
- Kidney stones. Urate crystals may build up in your urinary tract, forming kidney stones.
- Kidney disease and failure. Kidney stones as a result of urate crystals can build up in your kidneys, causing kidney damage which can result in kidney disease.
- Psychological and emotional problems. Chronic pain from chronic gout can affect your daily life, causing significant emotional distress.
Diagnosing Gout
Gout can usually be diagnosed based on your symptoms and the appearance of the affected joint. Some tests may be included in order to get a more accurate diagnosis. These include:
- Joint fluid test. Fluid is drawn from your affected joint. When examined under a microscope, urate crystals in the fluid will be visible.
- Blood test. A blood test can measure the uric acid levels in your blood.
- X-ray imaging. X-rays of the joint can allow your doctor to check for other possible causes of joint inflammation.
- Ultrasound. Sound waves are used to check for urate crystals in the affected joints.
- Dual-energy computerized tomography (DECT). X-ray images taken from many angles are used to check for urate crystals in your joints.
Gout Treatment
Gout treatment can be treated using medication, diet and lifestyle changes, and in severe cases, surgery.
Gout management methods include the following:
Medication
Medication used to treat gout includes:
- Nonsteroidal anti-inflammatory drugs (NSAIDs).
- Colchicine. An anti-inflammatory drug that reduces gout pain.
- Corticosteroids. Controls gout inflammation and pain.
Diet and Lifestyle changes
A diet that includes food high in purine can increase your body’s production of uric acid. This can cause your gout to worsen, making it important for you to change your diet in order to keep your gout in check.
Foods and beverages that are high in purine should be avoided if you have gout:
- Seafood such as sardines and anchovies
- Red meat such as beef
- Organ meats such as livers, hearts and intestines
Sweetened beverages that are high in fructose as well as alcohol, especially beer, should be avoided as much as possible as they also contain a high amount of purine.
Is surgery necessary for Gout?
Surgery is not necessarily used to treat gout but may be necessary when it comes to removing infected tophi or tophi that heavily limits your joint movement.
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