OUCH! It’s GOUT!

OUCH! It’s GOUT!
By Lim Chia Ying, RPh

 

What is GOUT?

Gout is a condition characterized by symptoms affecting the joints such as pain, redness, swelling, and extremely sensitive to pressure which eventually cause difficulties in getting around.

Gout is usually acute (short term) or can be chronic (long term). It often begins in one joint (big toes most commonly affected) and if left untreated may involve more joints. Each attack may last for several days.

What causes GOUT?

Purines are found in human cells and in many foods which will then be broken down into uric acid in our body. Uric acid is normally eliminated through urination. However, some people would overproduce uric acid or they could not eliminate uric acid properly, resulting in an excess build-up of uric acid in the body.

Gout is characterized by formation of crystalized uric acid in the joints and soft tissues, causing excruciating pain of gout.

What are the risk factors?

  • Gender: Male-dominant
  • High intake of beer and hard liquor
  • High intake of red meat, seafood, sugary soft drinks, and foods high in fructose.
  • Some medications like Thiazide and loop diuretic (water pill) have association with high risk of gout and flares.
  • Uncontrolled hypertension, poor cholesterol profile, renal insufficiency, high uric acid, diabetes, obesity and early menopause may raise the risk.

Management of GOUT: Medications

Acute GOUT management: Aim to reduce pain and inflammation

  • First line: Pain killer- NSAIDs (Diclofenac, Indomethacin, Ketoprofen)
  • Second line: Colchicine (if NSAIDs are contraindicated)

Chronic GOUT management: Aim to reduce uric acid in the body

  • Urate-lowering agents (Allopurinol, Probenecid) should not be started until the acute attack is settled.
  • However, for patient on long-term allopurinol, it should not be stopped during an acute attack.

Management of GOUT: Lifestyle modifications

Avoid

  • High purine organ meats (liver and kidneys)
  • High alcohol intake (>2 serving for males and >1 serving for females)
    High fructose beverage (soda) and food

Limit

  • High purine content seafood (shellfish, sardines), red meat (beef, lamb)
  • Naturally sweet fruit juice

Encourage

  • Weight loss, drink plenty of water, dairy products, vegetables, regular health check-ups, talk to your healthcare provider.

 

References:

  • Clinical Practice Guideline Malaysia: Management of Gout 2008
  • American College of Rheumatology: Guidelines for Management of Gout 2012.
  • Current Rheumatology Reports: Racial and Gender Disparities in Patients with Gout 2014
  • Medical Journal of Malaysia: Acute Gout in hospitalized patients in Sarawak General hospital 2014.