WHAT IS GOUT?

Image from Agency for Care Effectiveness (ACE) Guidelines 2019

Gout is a form of inflammatory arthritis which occurs due to excessive amounts of uric acid in the body, causing uric acid crystals to form.

 

Uric acid crystals normally accumulate in the joints and tendons, triggering intense inflammation and resulting in swelling, redness, burning sensation, and intense pain. 

It is a chronic – or long-term disease – but it can be managed with medications and lifestyle changes. Early detection of gout in its early stages can also reduce the occurrence and severity of the painful swellings that mark the disease.

People used to think that gout was caused by overeating and drinking too much alcohol. While this can make attacks of gout more likely, it’s not the whole story.

National Arthritis Foundation

Purine Sources

Purine is a naturally occurring substance found in food and the tissues of the body. 

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HOW IS GOUT CAUSED?

 

RISK FACTORS

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Anyone can get gout, but certain risk factors affect the onset of gout. 

These include:​

Family history

Some have a genetic disposition of kidneys which don’t flush uric acid out as well as they should. This is the most common cause of primary gout, especially when several family members are affected.

Gender & Age

Men aged 40 and above have a significantly higher risk for gout as they have less estrogen than women. The female hormone estrogen improves uric acid excretion by the kidneys. Hence, women's risk of getting gout increases at a much later age, after their menopause.

Obesity

Purines are found in food, and our tissues. When tissues are broken down, the purines in them convert to uric acid. More tissues in the body results in more uric acid. Hence, being overweight can lead to a higher chance of developing gout.

Excessive alcohol intake

Not only does alcohol break down to purines and uric acid, it also reduces the body’s ability to remove uric acid.

 

Beer, in particular, increases the risk of gout the most. 

Drinking artificially sweetened drinks

Sugary drinks are high in fructose which our body breaks down into purines which then breaks down into uric acid in our body.

 

Excessive fructose hence equates to elevated levels of uric acid in our body which then increases the risk of getting a gout attack.

High- purine diet

A diet that consistently contains a lot of high-purine foods, such as certain organ meats and red meats, sardines and anchovies can lead to high level of uric acid in the blood(hyperuricemia). In the long term, hyperuricemia may lead to gout.

Chronic kidney disease/ Kidney failure

Someone with an impaired kidney function will have difficulty clearing excess uric acid in their urine and are more prone to gout.

Other medical conditions

Certain conditions like 

high blood pressure (hypertension), diabetes, high cholesterol, arteriosclerosis, hypothyroidism and psoriaris (a skin condition) increase one's risk of getting gout.

 

People who have had

organ transplants are also at risk of developing gout.

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SYMPTOMS

When you have gout, urate crystals can build up in your joints for years without you knowing they are there. When there are a lot of crystals in your joints, some of them can spill out from the cartilage into the space between the two bones in a joint.

 

The tiny, hard, sharp crystals can rub against the soft lining of the joint, causing a lot of pain swelling and inflammation. When this happens, it’s known as an attack or flare of gout.

Here are some symptoms of a gout attack:

  • Sudden, intense joint pain (pain is most severe within the first 4-12 hours)

  • Can affect any joint but commonly affects the large joint of the first big toe

  • Redness, burning sensation, swelling and tenderness in the affected joints

  • Limited range of motion

  • Typically happens at night and can last 3-10 days

POTENTIAL NEGATIVE IMPACTS

 Attacks can vary from person to person. Some people only have an attack every few years, while others have attacks every few months.

Without medication, attacks tend to happen more often and other joints can become affected.

Having high urate levels and gout for a long time can lead to other health problems, including:

Tophi 

Untreated gout may cause uric acid crystals to not only be deposited in the joints but also under the skin to form lumps called tophi (pronounced ‘toe-fi’). These lumps are not painful, but can become sore and swollen during a gout attack.

Joint damage & deformity

 

The affected parts can become so swollen that it causes joint damage or even worse, permanent deformity. If it affects the feet and hands, the condition can

also limit actions like walking and typing.

Kidney Stones 

All that excess uric acid crystal may also  collect in the urinary tract, causing kidney stones.

Increased risk of kidney disease

​       A 2018 study published in Arthritis

Research & Therapy reported that

people with gout have a 78% higher risk of moderate kidney disease, which typically has no symptoms. The same study noted about 1 in 4 people with gout have this level of renal damage.  

 
 
 

Increased risk of cardiovascular disease 

Research links gout to an increased risk of several types of cardiovascular disease, including heart attack, heart failure, and atrial fibrillation, or an irregular heartbeat.

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Blood Test

A blood test may be used to check the level of uric acid level in your blood. This is not always accurate – some people have high uric acid levels, but never develop gout, while patients with gout suffering from a gout attack may have normal uric acid levels in their blood.

Joint Fluid Test

A more accurate way to detect if you have gout is to check if you have uric acid crystals in your joints. The test is called a joint aspiration, when a needle is used to draw some fluid from your affected joint and examined under the microscope. If there are uric acid crystals in the fluid, a diagnosis of gout is confirmed.

HOW TO DETECT GOUT?

If you suspect you are at risk of gout or have suffered an attack, it's best to seek medical advice from your medical practitioner (GP) who can help in diagnosing the condition and recommending the best way to tackle the disease.

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THINK YOU KNOW WHAT GOUT IS?