Gout / 27 Nov, 2019

Getting through a gout diagnosis

Dr Lau Pik Onn

What is gout?

Gout is a form of arthritis that causes sudden, severe episodes of pain, tenderness, redness, warmth and swelling of the joints.

The most common joint affected is the first joint of the big toe. Other joints that may develop gout include the ankle, foot, hand, wrist and elbow.

Gout occurs more often in men than in women. However, uric acid levels in women increase after menopause, making them more susceptible to gout.

What causes gout?

Gout occurs when deposits of needle like crystals of uric acid develop in the joint spaces of soft tissues, causing painful symptoms.

Uric acid, a substance that results from the breakdown of purines in the blood, passes through the kidneys into the urine. High uric acid levels (hyperuricemia) occur when its production is increased (e.g. due to consumption of food rich in purines or when its excretion is reduced from the kidneys, known as renal impairment).

Most people with gout have hyperuricemia, although not all people with hyperurcemia has gout.

Risk factors

Risk factors for gout include:

  • Consuming foods high in purine
  • Being overweight (excessive food intake increases the body’s production of uric acid)
  • Excessive alcohol intake (as alcohol interferes with the excretion of uric acid from the body)
  • Genetics
  • Lack of water intake (drink at least two litres per day to increase uric acid excretion)

Dietary considerations

Food to avoid (highest in purine)

  • All internal organs – liver, kidney, brain
  • Rich games – venison, pigeon, black chicken
  • Meat extracts – gravies, chicken essence, bah kut teh
  • Certain fish/shellfish – salmon, herring, mackerel, anchovies, sardines, cockles, mussels, scallops, prawns
  • Certain vegetables – spinach, peas, beans, peanuts, carrots, tomato
  • Bean products – bean curd, soya bean drinks, bean sprouts, bean cake, moon cake, legumes
  • Fruits – strawberries, durian
  • Alcohol – beer, champagne, brandy, whisky, port

Food to restrict (moderately high in purine)

  • Certain vegetables – cauliflower, asparagus
  • Mushroom
  • Breads – wholegrain, wheat
  • Oatmeal
  • Red meat

Importance of maintaining a normal uric acid level

Gout may also be associated with other problems like hypertension, diabetes, kidney diseases and obesity. Uric acid crystals can also form deposits in the kidneys or ureters leading to kidney or ureteric stones. Hence it is important to ensure a healthy diet and maintain a normal uric acid level.

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