Introduction

Gout is a disease in which there is a build-up of uric acid in the body.

• Uric Acid is a waste product formed from the breakdown of certain proteins (called Purines).
• It is normally removed from the body by the kidneys.
• In gout, uric acid builds up and forms crystals which are deposited inside the joints.
• It is one of the oldest diseases known to mankind.
• Although it was formerly a leading cause of painful and disabling chronic arthritis, due to advances in medical research, gout can now be well-controlled.
• It commonly affects middle-aged men , especially between the ages of 30 and 60.
• It rarely affects women before menopause.

Signs and symptoms

• The base of the big toe is usually affected.
• The big toe becomes red, hot, swollen and very painful.
• Attacks usually occur very quickly, often overnight.
• Affected joint becomes very painful , often to the point that even the weight of a bedsheet becomes unbearable.
• Pain may last for days to weeks if not treated.
• May recur at intervals of weeks or months.
• Gout can also affect other joints like the ankle, knee, wrist and fingers.

Complications

• Uric acid may collect under the skin as tophi
• In the urinary tract, it may collect as kidney stones.
• People with gout usually have other diseases like
  • Obesity
  • Hypertension,
  • Hyperlipidaemia
  • Diabetes

Treatment

Gout is a curable disease but you must take steps to overcome the disease.

Acute attacks

• Rest the joint during an attack of gout.
• Anti-inflammatory medicine is used to reduce pain and inflammation. It may have side-effects like pain in the abdomen but if used for short-term, it is generally well tolerated.
• Other drugs like colchicine can also be given. Although colchicine is very effective, it often causes nausea, vomiting and diarrhoea. (Can be prescribed only by doctors)
• Steroids
  • Usually injected directly into the inflamed joint
  • May be given as a short course of tablets if the patient is unable to take other medications. However, this is not to be taken long-term.
• Always be on the lookout for early signs of attacks . The earlier you start the treatment the better the outcome.

Long-term treatment

Since gout is caused by an excess of uric acid in the body, you have to remove factors that may raise uric acid level.

• Control your weight – Being overweight interferes with the body’s ability to remove excess uric acid (Click here to read more..)
• Avoid alcohol
• Diet – Avoid increased intake of purine-containing foods
• Certain meats, seafood, dried peas and beans are particularly high in purines.

Diet

Below is a list of food high in purines, especially organ meats.

Prevention

• Modify your lifestyle to maintain a normal uric acid level
• Maintain a healthy lifestyle to prevent the associated medical conditions
• Allopurinol once prescribed is regular life-long treatment
• Do not stop or change the dose of allopurinol when you have an attack
• Drink plenty of water

Is gout a disease of the wealthy?

No, gout can affect people from all walks of life although too much alcohol and overeating can be associated with its development.

Can gout be inherited?

• Gout can be inherited but environmental factors also play a part
• Gout is a treatable disease. Historically, gout has been a major cause of destructive and disabling arthritis but today with proper management it can be totally controlled.
• The main thing is to adopt a healthy lifestyle.

If you want more information on gout, visit the Arthritis Foundation Malaysia web site at www.afm.org.my