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Beginner's
Guide to GoutJan
2017

All you need to know about this lifestyle disease

Gout is often thought of as a modern-day disease. However, you may be surprised to know that gout is one of the most frequently recorded medical illnesses throughout history. Also known as gouty arthritis, it is a condition that results when uric acid is deposited as crystals in the joints. This results in joint inflammation, causing intense pain, redness and swelling. The signs and symptoms are similar to arthritis. The big toe is often the first to be affected. Other joints — such as the wrists, fingers, elbows, ankles and knees — could be affected as well.

Uric acid is a breakdown product of purines, which are found in many of the foods that we eat. An abnormality in the way the body handles uric acid can cause attacks of painful arthritis and other medical conditions such as kidney stones.

Gout typically affects middle-aged men who tend to be overweight and may also have high blood pressure, diabetes and high cholesterol — diseases that have been linked to lifestyle factors. If young people are affected, they tend to have a family history. Gout in women may be due to the use of medicines called diuretics that promote urine excretion. Patients with poorly functioning kidneys are more prone to gout.

How It’s Caused

Here are some of the risk factors for gout:

Lifestyle

About 12% of gout cases are linked to dietary causes. A diet rich in meat, seafood, alcohol and fructose-sweetened drinks could increase your risk of developing this painful condition.

GeneticsGout could be passed on from generation to generation. Several genes have been identified that are linked to an increased risk of hyperuricaemia (high serum uric acid level), which is the pathological basis of gout.

Medical Conditions

Gout is often diagnosed together with a couple of other medical conditions, including hypertension, obesity and insulin resistance.

Medications

Certain medications could be linked to the increased frequency of gout attacks.

Ways To Prevent It

Gout is a benign and seldom life-threatening condition, but the pain associated with it is usually unbearable and debilitating. If left untreated, the affected joints may become damaged and deformed, leading to a drastic drop in the quality of life. Other than the joints, the urate crystals may also accumulate within the skin and kidneys, leading to the formation of tophi and kidney stones respectively. These complications can greatly affect the daily life and psychosocial health of the patient.

Although painful and unpleasant, gout is highly treatable. While genetics and family history are predisposing factors that cannot be changed, patients with a history of gout are advised to modify their diet and lifestyle to prevent future attacks.

Foods such as organ meats, shellfish, legumes and certain vegetables such as cauliflower and mushrooms are high in purines. Consumption of these food types can increase the serum uric acid level, leading to an episode of gout attack. Some recent studies suggest that plant sources of purines are not as important, but for many patients, they remain a concern and should be avoided. Obesity is a known risk factor for gout, so exercising regularly and losing weight may be a good idea to reduce one’s risk.

The key to medical treatment of gout is keeping serum uric acid levels low. If you are able to adhere to a low-purine diet, medication may not be required. However, when there is poor control of the blood uric acid level, the chance of a repeat episode of gout dramatically increases, and oral medication is recommended to bring the blood uric acid level down. In an acute flareup, nonsteroidal anti-inflammatory drugs (NSAIDS) are usually given for symptomatic control. Colchicine is an important medication used to treat and also prevent gout flares in the joints. Medications such as allopurinol and febuxostat can be given to achieve the treatment target of serum uric acid of < 6mg/dl. This is the level below which crystals will not form.

Ultimately, strict dietary modification and the maintenance of good general health will go a long way towards preventing gout attacks.

Gout is a benign and seldom life-threatening condition, but the pain associated with it is usually unbearable and debilitating. If left untreated, the affected joints may become damaged and deformed.

About Our Arthritis Specialist

A/Prof Leong Keng Hong is a senior consultant Rheumatologist at Gleneagles Medical Centre and Adjunct Associate Professor, Yong Yoo Lin School of Medicine, National University of Singapore. He founded the Osteoporosis Society (Singapore) in 1996 and served as its President until 2004. He was also the Inaugural Chairman of the Chapter of Rheumatologists, College of Physicians, Academy of Medicine, Singapore from 2004-2007 and its current Chairman until 2013.

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