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Gout

Gout: What is it, Causes, Symptoms, Risk Factors, Diagnosis, Treatment Options | Singapore General Hospital

Gout - What it is

Gout is the most common type of inflammatory arthritis. It is caused by an excessive amount of uric acid in the body. Gout often causes excruciating pain and swelling in the affected joints, particularly the big toe. If left untreated, the joints may be damaged resulting in deformity and restricted mobility even after an acute attack has subsided.

Uric acid is a natural substance in your blood and is filtered by the kidneys. If the uric acid level is too high, urate crystals can form in the joints. This can cause pain and swelling in the joints.
 
Patients with gout do not suffer from continuous pain all the time. They experience sudden onset of joint pain and swelling during the “acute attacks”. When the acute attacks subside, they may feel well for months or even years, but the attacks may recur and become more frequent.

From a medical point of view, there are 4 stages of gout:

  • Asymptomatic phase - Patients have elevated levels of uric acid in the blood, but do not experience any pain or swelling. Not all patients with high uric acid will have an acute attack.
  • Acute gout - At this stage, uric acid crystals are deposited around the joint, causing sudden swelling and intense pain. This is commonly referred to as a gout attack.
  • “Interval” gout - In between gout attacks, patients may not experience any symptoms. The uric acid level remains high.
  • Chronic gout - If treatment is not sought, recurrent gout flares can cause damage to the affected joints, leading to joint deformity, chronic pain, and restricted mobility.

Most people with gout have their first attack between the ages of 30 to 40. The majority are men, although women may develop the condition after menopause. This is because the female hormone known as oestrogen can help to excrete uric acid from the body. Other diseases such as diabetes, hypertension, leukaemia, kidney disorders and certain medications can also cause gout.

Gout - Symptoms

The symptom of a gout attack is sudden, intense pain, swelling and redness of the affected joint. During this period, the skin around the joint may also be very tender to touch. Patients with an acute attack may find walking very difficult and painful.

In the chronic stage, patients may have persistent pain and reduced function of the affected joint. Urate crystals may also form tophi.

Gout - How to prevent?

​Diet and exercise will help prevent gout flares. This may include weight loss, reducing intake of food which are rich in purines and avoiding excessive alcohol. Your doctor may also prescribe appropriate gout treatment to reduce the inflammation and lower the blood uric acid level.

Gout - Causes and Risk Factors

Gout occurs when the blood uric acid levels are persistently above a critical level leading to formation of urate crystals in the joints. If left untreated, the joints may be damaged resulting in deformity and restricted mobility even after an acute attack has subsided.

A family history of gout is one of the risk factors. Gout is also linked to obesity, hypertension and diabetes. Some drugs like diuretics (commonly known as water tablets), can also cause gout.

Gout - Diagnosis

The diagnosis of gout is made based on symptoms, clinical examination and blood tests. X-rays can help in the assessment of joint damage.

The definitive test is a joint aspiration, where a needle is inserted into a swollen joint to obtain a sample of the joint fluid, for examination of urate crystals.

Gout - Treatments

Gout is treated with medications, dietary and lifestyle modifications.

  • Medications

Gout medications include medications to treat the acute inflammation during a gout flare and ongoing treatment to lower the blood uric acid level.

Treatment for acute gout attacks includes NSAIDs (non-steroidal anti-inflammatory drugs), colchicine and steroids. In a severe gout attack, your doctor may prescribe a combination of medications.

Ongoing treatment to control gout in the long term aims to lower the blood uric acid level and dissolve the urate crystals. Allopurinol, which reduces the production of uric acid, is often used. Febuxostat, a newer drug also blocks the production of uric acid. Probenecid helps the kidneys to remove uric acid. These drugs need to be taken long term in order to control the uric acid level and prevent further acute attacks. Your doctor can advise you on the medication you need.

  • Diet and lifestyle modifications

Limiting the intake of foods that are high in purine may be helpful. Foods that are high in purine, such as beef, liver, kidneys, and sardine should be avoided, and daily intake of protein-rich food like red meat should be limited. Avoid drinks high in sugar and fructose. It is essential to seek advice from a dietician for complete details.

Overweight and obese patients need to go on a supervised weight loss programme. However, fasting and crash diets are not recommended as they aggravate the condition.

  • Surgery

Surgery is rarely used to treat gout. It is sometimes required when there is a need to remove infected tophi or tophi that interferes with joint movement. Tophi tend to recur unless hyperuricaemia (high uric acid in the blood) is treated 

Gout - Preparing for surgery

Gout - Post-surgery care

Gout - Other Information

The information provided is not intended as medical advice. Terms of use. Information provided by SingHealth

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