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Gout

Understanding Gout

Gout is a type of arthritis caused by high levels of uric acid, resulting in the accumulation of urate crystals in the joint. Characterized by sudden intense pain, swelling, tenderness, warmth, redness and stiffness of the joint, this condition can attack anyone. It typically develops at the joint at the base of the big toe, though the joints in the wrists, elbows, fingers, ankles and knees can be affected as well.

Gout is a very common illness recorded throughout history. It often points to the inability of the body to process uric acid. An abnormality in handling uric acid not only triggers gout attacks but also other medical conditions such as permanent joint damage and kidney complications.

It is most common in men, though women are found to be more likely to develop the disorder after menopause.

Stages of Gout

As with several illnesses, a gout attack has various stages:

  • Asymptomatic Hyperuricemia

    In this phase prior to the attack, the uric acid level is increasing and urate crystals have begun to form, though no other symptoms have manifested.
  • Acute Gout

    This stage refers to the first gout attack triggered a sudden spike in uric acid levels, usually caused by excessive drinking. The resulting inflammation may last and intensify in the next 8 to 12 hours, with symptoms taking 7 to 10 days to completely go away.
  • Interval Gout

    This refers to the time between attacks, though low-level inflammation may be present, damaging joints.
  • Chronic Gout

    This stage is characterized by more frequent gout attacks and persistent pain. Uric acid levels remain high, increasing the risk of joint damage and immobility.
  • Thankfully, with lifestyle adjustments, gout, regardless of stage, can be treated and managed.

    Causes of Gout

    A gout attack, which comes suddenly, is the result of a condition known as hyperuricemia. It is characterized by excessive uric acid levels in the body.

    Uric acid is a chemical formed from a break-down of purines that are found in food and produced by the body. Normally, it dissolves in the blood as it travels to the kidney, and is expelled as urine. Certain factors can cause hyperuricemia, such as an overproduction of uric acid or the inability for the kidneys to process the substance. Left unmanaged, hyperuricemia results in gout.

    Both are commonly triggered by lifestyle choices, injuries, intake of certain medicines and health issues.

    Risk Factors Gout

    The risk of developing hyperuricemia and gout is largely influenced by a number of medical and lifestyle factors, which include:

    Age & GenderWomen are more prone to developing gout after menopause, while men generally produce higher levels of uric acid.
    Lifestyle ChoicesTwelve percent of what triggers an attack can be linked to dietary causes. A diet rich in purine such as meat, seafood, high-sugar drinks and alcohol not only increases the chance of developing gout, but also leads to obesity as well.
    Genetic Predisposition It has been discovered that there is a certain gene that increases or decreases the likelihood of a person getting gout.
    WeightObesity or excessive weight means more fat, which results in more uric acid.
    Health Conditions This type of inflammatory arthritis is often diagnosed together with other medical conditions such as kidney problems, hypertension, insulin resistance, diabetes and an underactive thyroid gland.
    Medication Certain medicines, including diuretics and those that contain salicylate, increase uric acid levels.

    Exposure to certain chemicals and recent trauma or surgery can also increase the risk of gout.

    Symptoms of Gout

    A gout attack occurs very suddenly without warning, usually in the middle of the night and after a bout of excessive drinking. The main symptom is a throbbing, intolerable pain followed by discomfort and swelling in the affected area.

  • Pain

    The worst pain is experienced during the first 12 hours after the initial attack. While gout commonly affects a single joint, particularly the big toe, it can spread to other joints when left untreated, covering the ankle, elbows, fingers, knees and wrists.
  • Discomfort

    Intense pain brought on by the attack will eventually subside into milder discomfort that can last for a few weeks.
  • Inflammation

    The affected joint will become red and swollen, and warm and tender to the touch.
  • Limited Mobility

    The pain and inflammation may be so severe that the flexibility and mobility of the joint will be affected.
  • Immediate medical care is necessary if the above symptoms are accompanied by fever and signs of infection.

    Diagnosis of Gout

    Because symptoms of gout are often associated with other conditions, doctors will carry out tests to provide accurate diagnoses.

  • Joint Aspiration

    Fluid from the affected joint needs to be drawn out via a needle and examined under a microscope for uric acid levels and urate crystals.
  • Blood Tests

    This is conducted to check for creatinine and uric acid levels in the blood.
  • X-ray

    Joint X-rays can be conducted to check for other causes of swelling or inflammation.
  • Ultrasound

    Urate crystals can be detected with musculoskeletal ultrasound.
  • Dual-energy CT Scan

    This is a more advanced form of imaging that detects urate crystals, even if there are no inflammation or swelling.
  • Treatment for Gout

    In the case of gout, prevention is better than cure. That’s why patients are recommended to change their lifestyles for the better after the initial attack. However, for most cases, gout treatment involves only prescribed medications. These can help to manage the pain, prevent further complications and reduce chances of future attacks. Common medications include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)

    These are given to reduce inflammation, though an overuse can result in stomach pain and ulcers.
  • Colchicine

    This is a pain reliever specifically designed to address gout pain, though it induces nausea, vomiting and diarrhea when taken in large doses.
  • Corticosteroids

    Available as a pill or injection, this medicine is used to manage pain and inflammation. Side effects are high blood pressure and sugar level, and mood shifts.
  • Our Services

    There are more than 100 different types of rheumatic disorders. Our team works together to diagnose and treat the full spectrum of these disorders, including autoimmune diseases, such as lupus, rheumatoid arthritis and psoriatic arthritis, as well as other forms of arthritis, such as osteoarthritis, gout and Gout. Treatments for the various conditions may include lifestyle changes, medication and surgery. A/Prof Leong will tailor each treatment plan to effectively manage the condition in each patient.

    Click on each service to find out more

    About Our Arthritis Specialist

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

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