Gout is a form of arthritis or joint inflammation where sudden pain, redness, warmth and swelling of a joint occurs, due to uric acid from the blood crystallising within the joint. The condition is called ‘Niao Suan’ by traditional Chinese physicians, a term many patients are familiar with.
An attack often occurs suddenly with the maximum intensity of pain reached within a few hours such that the sufferer may have difficulty even walking. This rapid development of pain is a feature that differentiates it from other forms of arthritis. Similarly, after some days, the pain and swelling subsides, hastened by medication, and things return to normal.
This is unlike other forms of arthritis where pain is present constantly.
The most commonly affected joints are those of the big toe, as well as forefoot, knee, ankle and elbow joints. The shoulders, hips and spine are rarely affected.
Uric acid, or urate, is a breakdown of
the product purine, a component of
DNA found in all cells. Urate is poorly
soluble. When the body produces
too much uric acid or the kidneys
cannot clear enough of it, or if there is
over-ingestion of high purine foods,
blood uric acid levels rise. This leads
to urate deposits of needle-shaped
urate crystals in the joint space. These
cause intense irritation producing the
symptoms of gout.
Obesity. Excessive food intake and a
large body type increases the body’s
production of uric acid.
Excessive Alcohol. Alcohol, especially
beer contains high uric acid. A typical
scenario of gout is a man after an
alcoholic binge, waking up in the
middle of the night with excruciating
pain in the big toe, ankle or knee.
Food. Food with a high purine content
include red meat, beans, nuts, seeds,
pulses and their products (e.g. soybean
products), certain rich fish like sardines and anchovy, salmon, organ meats like
intestines and offal (‘kway chap’) and
certain vegetables like spinach and
However, moderation in consumption
of foods, weight reduction and overall
healthy eating is advised rather than
total abstinence from such a long list
of food items some of which also offer
positive health benefits. Food accounts
for only 30 percent of uric acid in our
blood so even if none of the above are
consumed, there may still be gouty
attacks requiring medications.
Kidney disease. Someone with
impaired kidney function will have
difficulty clearing excess uric acid in
their urine and are more prone to
Age & Gender. Men are at higher risk.
The typical patient is often a middleaged
obese man. Women are at lower
risk until after menopause. The risk of
developing gout also increases with
age. Many elderly get attacks of gout
for the first time in their senior years.
Family history. There is a higher risk
of developing gout if a family member
already has gout.
Doctors diagnose gout when
symptoms affecting a joint are
sudden and severe with a swollen and
hot joint. There is often a previous
experience of a similar event, and a
return to normal after the ‘attack’.
Gout is also the likely diagnosis
when the ‘typical’ joints are affected,
especially the big toe, which can turn
A high blood uric acid level with these
symptoms suggests the diagnosis
of gout. However, a high uric acid
without gout symptoms does not
mean a diagnosis of gout. Patients
need not be treated based on a high
blood uric acid level alone if they do
not have attacks of joint pain.
Joint aspiration is a procedure where
a needle and syringe is used to
suction out a sample of fluid from
the affected joint. This is sometimes
done in specialist clinics both to
confirm diagnosis and relieve pain by
removing excess fluid from a badly
swollen joint. The presence of urate
crystals in this joint fluid seen under
a microscope definitively confirms a
diagnosis of gout.
Pain relief. Drugs which can rapidly
reduce pain and swelling are needed
in an acute attack. These include
non-steroidal anti-inflammatory drugs
(NSAIDs), steroids and colchicine.
Preventing future attacks
Drugs. Pain relief of the current
attack is not enough if the sufferer
has recurrent attacks. This is because
the joint will become damaged with
repeated attacks leading to chronic
pain and disability from a worn-out
Drugs that reduce blood uric acid
levels can prevent future attacks.
A drug called allopurinol is able to
decrease the production of uric acid.
The drug probenecid increases the
amount of uric acid passed out in the
A small percentage of people will get a
rash with allopurinol. When this occurs,
the drug must be stopped as the rash
can involve the whole body which
can be dangerous. If you are given
allopurinol, your doctor will warn you
about the possibility of this condition
called allopurinol hypersensitivity
Low purine diet. Food with high
purine content should be reduced.
Drink enough water. It is also
important to drink more water (at least
2 litres a day) unless instructed by a
doctor not to do so.
Avoid alcohol. The consumption
of alcoholic beverages should be
avoided, especially beer.
Reduce weight and lead a healthy
lifestyle. Weight reduction is also
important. For the typical middleaged
sufferer, gout is often the
manifestation of an unbalanced
diet, over-nutrition and lack of
exercise. An overall healthy lifestyle,
exercise, avoidance of alcohol, dietary
modification and weight reduction
goes a long way in gout control rather
than simply strict abstinence of one or
two food items.
Gout often occurs together with other
diseases due to lifestyle imbalance
such as high blood pressure, diabetes
and high cholesterol. If you have gout
it is important to screen for these
diseases as well.
Please consult your Family Doctor if you have any concerns
about your health.
Specialist services available at the following SingHealth
Singapore General HospitalTel: 6321 4377
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