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Gout

  • What is Gout?

    Gout is a common disease of the joints. You may experience sudden, severe attacks of pain, redness and tenderness in the joints, especially at the base of the big toe. You may wake up in the middle of the night feeling like your big toe is on fire.

    The affected joint is so tender that you may have difficulty turning over in bed. The most commonly affected joints are the big toe, foot, ankle, heel, instep and knee. Gout rarely affects the joints of the upper limbs such as the fingers or wrists.

  • Gout is caused by too much uric acid in the blood. When the kidneys cannot excrete excess uric acid in the urine, it is deposited in the joints, where it forms crystals (called tophi). These crystals cause swelling and pain. Other causes of gout include:

    • A diet that is excessive in proteins, fat and alcohol
    • Certain medications
    • Gender – Men are more likely to get gout but women have a higher risk of getting gout after menopause
    • Hereditary – Gout often runs in families with a history of gout problems
    • Other diseases such as diabetes, hypertension, leukaemia and kidney disorders

  • The first sign of a gout attack is a sudden warm throbbing of the affected joint. This pain can quickly become excruciating and there is swelling and redness of the joint. Other symptoms include:

    • Difficulty and pain in walking during an acute attack
    • Extremely large uric acid crystals (tophi) in the joints or other tissues
    • Ongoing (chronic) pain with reduced movement in the involved joint
    • The skin around the joint being tender, sensitive, and sore, and extremely painful to touch

    The initial episode usually subsides completely within a week.

  • There is currently no cure for gout but the symptoms can be controlled by a combination of medication and diet:

    • A low-purine diet is recommended to reduce the level of uric acid in the blood (purine is broken down by the body where it is changed to uric acid):
      1. Avoid foods that are rich in purine such as alcohol, liver, kidney, salmon, sardine, dry beans, bean curd and soya bean
      2. Limit your daily intake of protein-rich food such as red meat
    • Non-steroidal anti-inflammatory drugs to reduce the pain, swelling and stiffness
    • Steroids can be used for an acute attack and can be injected directly into the joint if the pain is extreme
    • Surgery is rarely used to treat gout but may occasionally be needed to remove infected uric acid crystals or those that interfere with joint movement

    Uric acid crystals tend to recur unless the high uric acid level in your blood is reduced.

  • If gout is left untreated, your joints may be damaged, causing deformity and restricted mobility. Deposits of uric acid crystals may form under the skin in nodules. Gout episodes may become more frequent if the high uric acid level is not reduced. Uric acid crystals may collect in the urinary tract, causing kidney stones. If you have chronic gout, you may have reduced kidney function or kidney failure and high blood pressure.

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