What is gout?
Gout is a chronic disease with intermittent painful arthritis, commonly big toes, foot, ankles or knees. Gout attacks are episodes of sudden pain in the joint, which rapidly becomes red, hot, swollen and painful, with severe limitation in joint function (e.g. walking). Initially gout attacks usually affect one joint with complete resolution of symptoms in between attacks. At later stages, gout attacks can involve multiple joints, including those in the upper limbs.
Why does gout happen?
Uric acid is produced in the body during the breakdown of purines. Gout is caused by an excess of uric acid in the blood (hyperuricemia). Uric acid may form crystals that build up in joints and tissues, resulting in inflammation and intense pain. Chronic deposition of uric acid crystals leads to visible lumps called tophi.
Who does gout affect?
Gout affects mostly men, starting in their 30s and increases with age. It is less common in women until they reach menopause. Gout is often associated with various other medical conditions such as kidney disease, high blood pressure, obesity and heart disease. Often, patients have family members affected by gout. Consuming foods rich in meat, seafood and alcohol predisposes a person to gout.
Why should we treat gout?
Gout can be easily managed with medications and lifestyle modifications. From the patient’s perspective, gout attacks cause excruciating pain, limit daily activities including walking, and tremendously affect people’s work and social life as well as mood. Recurrent attacks of gout may cause permanent damage to the joints and tendons. In addition, high uric acid levels can lead to urinary stones and kidney problems, increase the risk of heart disease, and increased cardiovascular mortality.
How do we treat gout?
Acute gout attacks are treated with medications, such as :
- Nonsteroidal anti-inflammatory drugs (NSAIDs) – E.g. Naproxen, Diclofenac, Indomethacin
- Corticosteroids – Oral prednisolone or steroid injection into affected joints
It is important to note that not all the medications above are suitable for every patient. Factors such as drug allergies, kidney disease may mean that certain medications need to be avoided.
Reduction of uric acid is the mainstay of treatment of gout and will reduce attacks. A good target uric uric acid level is less than 360µmol/L – or 300µmol/L in patients who have tophi. Medications such as allopurinol, febuxostat or probenecid can be used. Again, the doctor will review your medical background to decide on the most suitable medication.
This condition is managed by the Division of Rheumatology.