My Joints Hurt, do I have Gout?

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Gout is a condition caused by excess uric acid in the body. Uric acid is a byproduct of the breakdown of purine in the body. Purine is a chemical compound found in a wide variety of foods.

When the uric acid levels in the body are too high, the body is unable to remove the uric acid quickly enough. This results in the build-up of uric acid crystals in joints. The accumulation of uric acid crystals results in localised inflammation, swelling, and pain, the symptoms of gout.

What can trigger gout attacks?

Purines are found in many sources of food, especially in animal products. The following are some high-purine foods where overconsumption may increase the risk of a gout attack. (This list is not exhaustive)

  • Organ meats (liver, kidneys, intestines)

  • Red meat and game meat
  • Soybean products
  • Alcohol and beer
  • Drinks sweetened with fruit sugar (fructose)
  • Some seafood (i.e. sardines, mussels, scallops)

Dehydration may also trigger gout attacks. In some patients, gout may be caused by underlying conditions such as certain types of cancer. If in doubt do seek early medical attention.

What are the signs and symptoms of a gout attack?

These are some common signs and symptoms experienced by gout patients,
● Sudden extreme pain at joint(s)
● Redness, swelling, tenderness, and warmth at the affected joint
● Stiffness of affected joint
● Fever and chills
● Patients may find themselves unable to walk or stand properly
● Occasionally, patients may develop permanent lumps around the joint with whitish lumps seen through the skin (Tophaceous gout)

Gout attacks usually happen suddenly, and often at night. They can go away in a few hours, but symptoms can also last for more than a week. Commonly affected joints include the big toe joint, ankles, knees, elbows, wrists, forefoot, and fingers.

How is Gout diagnosed?

Your doctor will conduct a medical interview, during which questions pertaining to the location, intensity, and type of pain might be asked. You will also be asked about possible triggers, especially dietary triggers.

Based on the information gleaned, a focused clinical evaluation will be conducted on the affected areas of your body. This is usually followed by plain X-rays of the affected joints, and blood tests. The blood tests will usually include a measurement of your blood uric acid levels.

For patients with large swellings of joints such as the elbow, knee, and ankle, a needle may be introduced to remove fluid from within the joint for testing. This is the gold standard diagnostic test, as the presence of uric acid crystals in the joint fluid will confirm the diagnosis of gout.

What are my treatment options?

The main goal of treatment would be to reduce the levels of uric acid present in the body, as it is the primary cause of gout. Although gout cannot be completely cured, it can be treated successfully to prevent future gout attacks. Strategies for the treatment of gout include,

  1. Lifestyle changes

    a. Dietary changes
    i. This mostly involves avoiding foods that are high in purine such as organ meats, red meats, some types of seafood, and sugary foods.
    ii. Having a healthier diet with fruits and vegetables, whole grains, and low-fat products.
    b. Removal of certain medicines such as diuretics, which are medications that induce urination. Some diuretics may not be suitable for patients with gout.
    c. If one is obese, losing weight is also encouraged
    d. Avoid alcohol
    e. Drinking more fluids, as proper hydration can help remove excess uric acid present in the body.

  2. Medications are used both to treat acute attacks and for the prevention of future gout attacks.
    a. A combination of anti-inflammatory painkillers and colchicine may be used for acute attacks
    b. If you suffer from frequent attacks, urate lowering therapy (ULT) may be necessary. The criteria for ULT is,
    ● Frequent acute gout flares (2 or more per year)
    ● Presence of any tophus
    ● Clinical or imaging findings of gouty arthropathy
    ● History of urolithiasis (kidney stones)

Surgical treatment is usually not necessary for most patients with gout. It is sometimes necessary if there is,
● Permanent joint damage as a result of gout. In this case, joint replacement surgery may be offered, especially in the knee.
● Large and painful tophi which affect joint function may necessitate debridement of the tophi.

Unlike most chronic diseases, gout does not cause consistent symptoms to the patient except during gout attacks. However, it is a progressive disease that will worsen and potentially cause other problems when left untreated. With treatment, most patients will be able to continue daily life as normal.

For an assessment of your condition, please book an appointment with Dr. Yong Ren.

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Sarah Taylor

Obstetrics & Gynaecology