Approximately 4.1% of Singaporeans have gout, a form of arthritis that commonly affects our big toe and other joints. Learn more about gout and gout attacks, and its causes, symptoms, treatment and prevention here.
What is Gout?
Gout is a form of arthritis – a disease which causes pain and swelling in the joints. The most common place to get gout is the joint at the base of the big toe, but it also commonly affects fingers, other toes, knees and elbows. Gout can cause swollen and lumpy-looking joints, and sudden attacks of severe pain.
Gout occurs when we have too much uric acid in our blood, which can cause small crystals to build up in our joints, resulting in pain, swelling, and difficulty moving the affected joints. These uric acid crystals may also deposit under our skin and form raised white lumps called ‘gouty tophi’.
Globally, gout is becoming increasingly common, likely due to changes in diet around the world over recent years and an ageing population. Gout affects nearly 7% of the overall population in the areas where it is most common and approximately 4.1% of the population in Singapore.
What Causes Gout?
When our bodies break down purines, a chemical naturally found in our bodies and food, uric acid is produced. While this is a normal and natural process, having too much uric acid in our blood can cause crystals to build up in the joints, causing gout.
Some of the things that make a person more at risk of getting gout cannot be changed – these are known as non-modifiable risk factors. Some of the things that make us more at risk of gout can be managed – these are known as modifiable risk factors.
Modifiable Risk Factors
Food with high purine content, such as meat, seafood, fruit juices and sugar-sweetened drinks, can increase our risk of gout. Alcohol consumption, especially beer, can also lead to gout and other health conditions.
Being overweight increases your risk of gout, even with a relatively healthy diet. This is because your body produces more uric acid and your kidneys have a harder time processing and eliminating them.
Non-Modifiable Risk Factors
Having a family member with gout puts us at a higher risk of developing gout.
Gout becomes more common as we get older, partially because we are more likely to be affected by other illnesses as we age too.
Often thought of as being a man’s condition, gout affects over four times more men than women. Women may also develop the condition, but this usually only happens after menopause as oestrogen released during the female reproductive cycle speeds up the removal of uric acid by the kidneys.
People from African-Caribbean backgrounds are more likely to have gout than people of white European backgrounds, and the likelihood of having gout is much higher again in people from parts of South East Asia and Australasia.
Gout tends to go hand-in-hand with other illnesses such as cardiovascular disease or kidney disease. Sometimes, having other illnesses makes it harder to treat gout or can mean that doctors have to be careful when choosing which medications to prescribe.
The use of certain medications such as low-dose aspirin and thiazide diuretics (commonly prescribed for hypertension) can cause a rise in uric acid levels.
When we are unwell or less able to be active, engaging a dedicated carer to visit us at home and assist with daily activities can be helpful.
Symptoms of Gout
Gout usually causes red, swollen joints. The swelling might make the joints feel large, hot, and tight. Gout can be painful and may affect people’s lives and their ability to take care of themselves properly. Joint pain is usually most severe within the first 4 to 12 hours, and the lingering discomfort may last from days to weeks afterwards. As gout progresses, you may not be able to move your joints normally.
The symptoms of gout can be similar to the symptoms of other conditions, which is why it’s important to see a licensed healthcare professional for a definite diagnosis. Without an accurate diagnosis, you could get the wrong treatment which is likely to be ineffective or even harmful.
Joint pain can arise from a number of conditions, so you should consult a licensed doctor for an assessment and to confirm a diagnosis. There are several different treatments available for gout so it’s important to consult a medical professional, who can then create a tailored treatment plan for you.
To diagnose gout, a doctor will examine your joints and ask about diet and risk factors such as family history of gout. They may take a blood test, arrange an x-ray, and use a fine needle to take a small sample of fluid from the joint.
What is a gout attack?
A severe attack of gout, known as ‘acute gout’ or a ‘flare up’ of gout can come on suddenly. However, people can often go for long periods between attacks. Gout attacks sometimes seem to be brought on by periods of stress or other illness. People who are prone to gout might find that an attack can come on after banging the affected joints, such as after bumping an elbow or bruising a knee.
In a severe attack of gout, the pain and difficulty of using the affected joints can have a serious impact on your life, affecting mobility, sleep, and your ability to perform day-to-day tasks. Simply living with pain can have its own adverse effects on both physical and mental well-being.
Managing gout attacks
In the short term, there are simple steps you can take to try and manage an attack or ‘flare up’ of gout. If you have medication on hand, take them. Elevating and/or icing the affected area may also help to alleviate pain and swelling. Should you need to move around, try walking with a cane to take pressure off the painful joint.
Getting treatment within 24 hours of a gout attack can help to reduce its length and severity. If you experience a sudden bout of gout attack, let your doctor know as soon as possible. Your doctor may then prescribe medication, conduct a joint fluid test or inject medication to relieve the inflammation quickly. Visiting a family doctor when having a gout attack, however, can be difficult due to the pain, so a home visit by a licensed doctor may be a better option.
Potential Complications of Untreated Gout
If left untreated, gout can cause long-term damage to the joints and has the potential to be harmful and debilitating. Without proper management, a gout attack can become serious and cause permanent damage to the joint.
The ongoing inflammation and build-up of irritant crystals in the joints of a person with gout can increase their risk of joint infection. As the symptoms of joint infection can easily be confused as a mere gout attack, people often are unaware that their joint is infected, resulting in delayed treatment. This can lead to septic arthritis, a potentially life-threatening condition.
Those who are more likely to develop gout due to non-modifiable risk factors such as gender or family history should take extra care in managing the risk factors you can control. Adjusting your diet and maintaining a healthy weight can not only help to prevent gout, but also reduce your risk of other diseases.
Managing Gout with a Healthy Diet
Adopting a gout-friendly diet that is low in purines can greatly reduce our risk of developing gout and the frequency of gout attacks. Eating lots of fruit and vegetables and avoiding the foods known to contribute to gout are great ways to maintain a healthy weight, an important way to prevent gout, and to stay healthy all-round.
Here are some foods that can help to prevent or manage gout, and foods that persons with gout should avoid.
Foods that help to prevent gout
Staples such as rice, potatoes, corn-based foods, and wheat-based foods like bread can help to reduce our risk of gout. The best kind of carbohydrates to choose for all-round health and to prevent gout are complex carbohydrates. Complex carbohydrates such as wholegrain foods and brown rice take longer for the body to break down and improve gut and cardiovascular health.
Drinking plenty of fluids is important to reduce the impact of gout, as well as to boost general health and kidney function. Most people should aim to drink 8 eight-ounce glasses of water a day – that’s around 2 litres. However, if your doctor has told you to limit your fluid intake, it’s important to follow the advice of the healthcare professional who knows you best.
Fruit and vegetables
A healthy diet should contain a wide variety of fruits and vegetables to maintain overall health and lower the risk of gout.
Whenever possible, choose fish, poultry, low-fat dairy, and plant-based proteins over high-fat meats such as beef.
Foods to avoid
Reducing your intake of meat, especially purine-rich meat, can significantly reduce your risk of developing gout.
Organ meats (offal)
Liver, kidneys, sweetbreads and other organ meats are also known to trigger gout and gout attacks.
Shellfish, anchovies and sardines in particular are high in gout-causing purines. However, moderation is key as fishes do have many other health benefits.
Drinking alcohol is one of the most well-known triggers for gout. Certain types of alcohol seem to carry the most risk – beer and strong spirits particularly – but avoiding or reducing alcohol intake in general is recommended for people prone to gout, especially during a flare-up.
Fructose is a sugar found in fruit that’s closely linked to gout risk. Foods that are highest in fructose are sugary soft drinks, juices and heavily processed sugars like corn syrup. While fruit itself does contain fructose, it is still an important part of a healthy diet. Hence, those with gout should continue to eat fruit in moderation but avoid processed sugars and soda as much as possible.
Studies have shown that people who eat eggs, dairy products and plant-based foods had the lowest risk of gout, and while people who followed a strictly plant-based diet were slightly more prone to gout, the group that ate the most meat were at significantly higher risk.
If you’re looking to reduce your meat intake, vegetarian meat alternatives are available, but some are better than others at reducing gout risk. Mycoprotein-based foods such as Quorn™ and soya proteins are relatively higher in purines compared to wheat or egg-based proteins.
Medications for Gout
While a healthy diet and lifestyle are great ways to prevent gout and many other diseases, people who experience attacks of gout may also be prescribed medications. Some medications are taken long-term to reduce the risk of recurrent attacks, while others are to be taken during a gout attack.
Medications for long-term gout prevention
Long-term medications are usually prescribed to lower the amount of uric acid in the body. They work by either reducing the amount of uric acid produced or controlling the way it’s expelled from the body. The most common medications for long-term gout treatment are taken in pill form, and include:
- Allopurinol reduces the amount of uric acid the body produces. It is not usually started during an acute attack of gout – it can make a flare-up worse, although in the long run it reduces the risk of further attacks.
- Febuxostat works in a similar way to allopurinol to prevent the body from producing as much uric acid.
- Probenecid helps to increase the amount of uric acid expelled by the kidneys, reducing the amount in the body.
Your doctor may recommend taking medication everyday to prevent gout. This may mean taking it even when you’re not experiencing symptoms of gout. After all, prevention is always better than cure.
Medications for acute attacks of gout
Painful attacks of gout are usually managed with anti-inflammatory medication – medicines that help to reduce swelling. These kinds of medicines are sometimes known as ‘NSAIDs’. Here are some of the common medication prescribed for gout attacks:
- Ibuprofen is the most common NSAID, which may come under the brand name Nurofen.
- Colchicine is another medicine commonly used in an attack of gout.
Colchicine and ibuprofen can both cause some side effects, hence are usually only recommended for a short period of time, or in low doses for longer-term management.
While aspirin has anti-inflammatory properties, it is not recommended for treating gout. However, if you have to take aspirin for another reason, such as to manage heart disease or stroke risk, it’s important to keep taking it unless a doctor tells you not to.
Living with Gout
Gout can be an incredibly painful disease and may cause long-term problems if it isn’t treated properly. The risk factors for gout are also risk factors for other serious diseases, and so people with gout often have more than one health problem.
As with any health or mobility problems that make us less able to look after ourselves, it can sometimes be difficult to continue to live the kind of life we enjoy with gout. Having dedicated and professional home carers can give us the help we need through difficult times, when we just need a little extra help at home or to get outside. High quality care in the the comfort of home means that you can maintain the healthy, active and enjoyable lifestyle that you deserve.
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