The one symptom of gout you shouldn't ignore

Have you ever woken up in the middle of the night with intense pain in the big toe, almost as if your toe were on fire? This is often the first sign of gout, a common and complex form of arthritis that occurs when there is excessive uric acid in the blood. Let’s read more about this condition, its causes and symptoms, and foods that cause gout.

What is gout?

Gout is a form of arthritis that causes sudden, severe episodes of pain, tenderness, redness, warmth and swelling of the joints. It most commonly affects the big toe, but may also affect the ankle, hand, wrist, or elbow.

Gout is often associated with other medical conditions such as kidney disease, high blood pressure, obesity and heart disease. It is the most common type of inflammatory arthritis in men over the age of 40. Women are usually protected from gout until after menopause.

More young Singaporeans these days are getting gout, possibly due to the consumption of high-protein diets, increased alcohol intake, and lack of water intake.

What causes gout?

Gout is caused by too much uric acid in the blood. Gout occurs when urate crystals (crystals of uric acid) accumulate in your joint, causing inflammation and intense pain.

Uric acid, a substance that results from the breakdown of purines in the body, usually dissolves in the blood and passes through the kidneys into the urine. In people with gout, the uric acid level in the blood becomes elevated.

This is called hyperuricaemia and it can either be due to the increased production of uric acid (due to consumption of food rich in purines), or decreased excretion of uric acid from the kidney (due to renal impairment.)

Risk factors of gout

• Obesity: Being overweight and excessive intake of food increases the body’s production of uric acid

• Diet: Excessive consumption of alcohol, and eating a diet rich in meat, seafood and other foods rich in purine increases your risk of gout.

• Medical conditions: Certain diseases and conditions increase your risk of gout. These include untreated high blood pressure and chronic conditions such as diabetes, metabolic syndrome, and heart and kidney diseases.

• Some medications: Use of certain medications such as diuretics, salicylates, cyclosporine, niacin, levodopa

• Recent surgery or trauma

• Age and sex: Gout occurs more often in men, mainly because women tend to have lower uric acid levels. After menopause, however, women’s uric acid levels approach those of men. Men are also more likely to develop gout earlier, usually between the ages of 30 and 50, whereas women generally develop signs and symptoms after menopause.

• Family history of gout: If other members of your family have had gout, you’re more likely to get it too.

Symptoms of gout

The signs and symptoms of gout almost always occur suddenly, and often at night. They include:

·        Intense joint pain

Gout usually affects the large joint of your big toe, but it can occur in any joint. Other commonly affected joints include the ankles, knees, elbows, wrists and fingers. The pain is likely to be most severe within the first four to 12 hours after it begins.

·        Lingering discomfort

After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.

·        Inflammation and redness

The affected joint or joints become swollen, tender, warm and red.

·        Limited range of motion

As gout progresses, you may not be able to move your joints normally.

Foods that cause gout

The following foods are high in purine content, and hence to prevent gout you should limit your intake of:

• Asparagus

• Cauliflower

• Mushroom

• Oatmeal

• Wholegrain

• Wheat germ

• Red meat

These foods have the highest levels of purine, so you should avoid them as far as possible, if you are prone to gout:

• Internal organs of animals and birds like liver, kidney, brain, pancreas

• Rich games  like venison, gamebird pigeon, black chicken

• Meat extracts like broths, meat stocks, chicken essence, bak kut teh

• Certain Fish/ShellFish like salmon, herring, mackerel, anchovies (ikan bilis), sardines, cockles, mussels, scallops, prawns

• Certain Vegetables like spinach, peas, beans, peanuts

• Beancurd, soya bean drink, bean sprout, bean cake, moon cake, legumes

• Fruits like strawberries, strawberry jam, durian

• Alcohol like beer, champagne, brandy, whisky, port

Here are more tips to prevent future gout attacks:

·        Drink plenty of fluids

Stay well-hydrated, and drink plenty of water. However, restrict your intake of sweetened beverages, especially those sweetened with high-fructose corn syrup.

·        Limit or avoid alcohol

Alcohol, especially beer, is rich in purine.  

·        Get your protein from low-fat dairy products

Low-fat dairy products may actually have a protective effect against gout. Limit your intake of meat, fish and poultry.

·        Maintain a desirable body weight and exercise regularly

If you are overweight, your body will produce more uric acid. So watch your weight, but avoid any sort of crash dieting or fasting, as doing so can temporarily raise uric acid levels.

Treatment of Gout and Complications

There is currently no cure for gout but the symptoms can be controlled by a combination of medication, lifestyle changes and a special diet:

• In order to reduce the level of uric acid in the blood, avoid foods that are rich in purine, and drink plenty of water

• Colchicine (an anti-gout medicine) is effective for relieving acute pain (within the first 12 hours) and can also prevent acute attacks

• Non-Steroidal anti-inflammatory drugs may be prescribed to reduce pain, swelling, and stiffness

• Steroids may be prescribed for an acute attack, and can be injected directly into the joint if the pain is extreme

• Surgery is rarely used to treat gout, but may occasionally be needed to remove infected uric acid crystals, or those that interfere with joint movement

• Your doctor will advise you regarding the types of medication(s) you need and monitor their side-effects.

If gout is left untreated, your joints may become damaged,  causing deformity and difficulty in movement/walking. Deposits of uric acid crystals may form under the skin in nodules.

Gout attacks may become more frequent if the high uric acid level in the blood is not reduced. Uric acid crystals may collect in the urinary tract, causing kidney stones. If you have chronic gout, you may have reduced kidney function or kidney failure and high blood pressure.

(Source: Sing Health, Mayo Clinic, GlenEagles Singapore, 

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