What is gout?
Gout
What causes gout? Gout is caused by too much uric acid in your body. Uric acid is a normal waste product from the breakdown of purines found in most foods. It accumulates when the body produces too much of it, or the kidneys do not clear it fast enough. Who gets gout? Almost all people with gout have high levels of uric acid (hyperuricaemia) in the blood. However not everyone with hyperuricaemia has gout. It affects more men than women and can affect men of any age. Women rarely develop gout before menopause.
Hyperuricaemia and gout may be inherited, or occur as a complication of other conditions such as kidney failure and leukaemia. Gout is also associated with diabetes mellitus, high blood pressure and high cholesterol. Some medications may make gout worse. What are the signs of an attack of gout? An acute attack often occurs suddenly, resulting in severe pain in a few hours. The joint (most commonly the big toe or knee) can be extremely painful and is often swollen, warm and red as well. Drinking alcohol, over-eating, extreme dieting, surgery or injury to joints can trigger an acute attack.
Gout is a disease that occurs in some people who have high urate (uric acid) levels in the blood. In these people, the urate deposits as crystals in the joints and other tissues, causing sudden attacks of extremely painful, swollen, hot joints.
Initially, the attack will settle and the patient will be symptom free until the next attack. If the disease is not controlled, attacks may become more frequent and last longer. Over time, more joints may be involved and can be damaged, resulting in stiffness, pain and deformity.
A history of acute attacks separated by symptom-free intervals would strongly suggest gout. This can be confirmed by the presence of tophi or by removing fluid from affected joint and identifying urate crystals.
2. Colchicine 0.5 mg two to three times a day. Colchicine may also be used to prevent attacks of gout. Common side effects include diarrhoea, nausea and abdominal cramps.
How is gout diagnosed?
1. NSAIDs (Non-steroidal anti -inflammatory drugs) like Indomethacin and Diclofenac.
3. Low doses of oral steroids –these may be needed in patients who are unable to take NSAIDs. Steroids may sometimes be injected into the joint to provide NSAIDsrelief.and steroids should not be used on a long-term basis in view of their side effects.
In some patients who have gout for a long time, large deposits of urate crystals collect in the tissues. These form lumps that are called tophi and may be found around joints or along the outer edge of the ears. Urate crystals can also form stones in the kidney and its collecting system. These stones can cause pain (colic) and kidney damage through repeated infection or obstruction to the flow of urine.
The management of gout involves treatment of the acute attack, as well as lowering urate levels to prevent recurrent disease and progression. What should I do during an acute attack of gout?
What is the treatment for gout?
1. Rest the joints.
2. Take medication to reduce the inflammation. Your doctor will decide what kind of drug is best for you. It is most useful to start treatment early in the course of an attack. Medications for acute attacks of gout
What happens if gout is not treated?
Uricosuric drugs lower the blood level of uric acid by increasing its excretion in the urine. Patients should drink plenty of fluids as the increased excretion of uric acid in the urine may lead to the formation of stones in the kidneys and collecting system. Surgery Surgery is rarely used to treat gout. Occasionally surgery is required to remove tophi if they are infected or interfere with joint movement. In patients with crippling joint disease, surgery to the joints can improve function and mobility. Therapy to prevent further attacks • Dietary modifications may be useful in lowering the blood urate level.
A number of medications can be used to lower urate levels in the blood. For the treatment to be effective and long lasting, these must be taken regularly and on a long-term basis. Stopping the medication can result in a recurrence of gout.
Allopurinol is one of the more commonly used medications. It works by preventing the formation of urate. It will also reduce tophi size and prevent urate from forming crystal deposits. Side effects include allergic reactions involving the skin, liver and kidneys, or gastrointestinal upset.
1. Allopurinol
Medication to prevent recurrent attacks of gout
2. Uricosuric agents (probenecid, benzbromarone)
• Obesity is often associated with gout and patients should try to lose weight gradually.
GROUPFOOD LOW PURINE (negligible purine content) USE AS DESIRED MODERATE PURINE (9-100mg purine/100g) USE IN MODERATION HIGH PURINE (100-1000mg purine/100g) AVOID &Breadscereals Breads & noodles,cereals,rice,cornbread Oatmeal, wheat bran, wheat germ, wholemeal bread, brown rice Fruit All, including juices* Vegetables Most vegetables Asparagus, cauliflower, spinach, mushrooms, green peas (Can be taken as part of your diet**) Protein PeanutEggs,butter(2Tbsp) 2-3 servings daily. 1 serving is: • Meat, fish, poultry (90g) • Tofu (170g) • Dried peas/beans/ lentils (120g or 3/4 cup cooked) Liver, kidney, heart, brains, sweetbreads, game meats, goose, anchovies, sardines, mackerel, herring, scallops, mussels Milk productmilk& All dairy products Gravy Fats & Oils All (in moderation) Soup Vegetable soups made from vegetable stocks Meat soups & broths Meat extracts (e.g. Marmite®, Bovril®), Yeast taken as a supplement Others • Gelatin • Cereal beverages • White sauce • Condiments such as salt, herbs, olives, pickles, relishes vinegar, popcorn • Tea, coffee • Sugar, syrup, sweets* • Chocolate, custard, pudding* • Soft drinks, alcohol* * Recommended in moderation due to ability to increase uric acid levels or high calorie content. **Monitor symptoms, individuals may respond differently to certain foods.
Admiralty Medical Centre • (65) 6807 8000 • www.admiraltymedicalcentre.com.sg
This brochure serves as an informational guide only. It is not intended to replace professional medical advice. Speak to your doctor, pharmacist or nurse for more information.
The information is correct at the time of printing and subject to revision without further notice. GM.PE.05.0722
Khoo Teck Puat Hospital • (65) 6555 8000 • www.ktph.com.sg
Yishun Health is a network of medical institutions and health facilities in the north of Singapore, under the National Healthcare Group.
Yishun Community Hospital • (65) 6807 8800 • www.yishuncommunityhospital.com.sg